House of Commons Hansard Debates for 18 Apr 1991

Dr. David Clark : The Minister is misleading the House.

Mr. Gummer : The hon. Gentleman says that I am being misleading. I did not take every opportunity in the House to stir up scares, problems and difficulties. I was not the one who was attacked by the hon. Member for Ceredigion and Pembroke, North for letting farming down by attitudes over beef problems. I did not recommend in the House that people should eat New Zealand apples because British apples were not good enough. I was not the one who said on television that I would not eat a British sausage. The hon. Gentleman now has reason to believe differently. The Opposition said all those things. Anyone who dares to suggest that he has any interest at all in British farming should consider what he says about British food, which is the best, the safest and the most surveyed food in the world. It does not deserve what, for several years, the Labour party has attempted to do to it.

My hon. Friend the Member for Somerton and Frome (Mr. Boscawen) again displayed his deep understanding of agriculture and his concern for those who work in it. I share his concern about pollution regulations, but if agriculture is to prove its worth it is essential that the rare instances of river pollution and so on, which have been a real scandal, should not be repeated. Farmers do not want to see their industry besmirched as it has been by a few people who have broken the law so dramatically. We provide high grants for the work that has to be done in pollution control. I am pleased that I was able to announce changes to an unnecessarily difficult part of the regulations which meant that farmers could not get a grant if they had already started on the work. The changes mean that not only will they be able to start the work before claiming the grant, but they will be able to make grant applications for work that has been completed and for which they had failed to receive grant because of the rule. I thank the House for agreeing to that and I hope that hon. Members will not mind the small element of retrospection which is fair for farmers.

My hon. Friend the Member for Somerton and Frome spoke about the Milk Marketing Board. We must enable the British farmer to receive a proper return for his products. To do that we must pay heed to the fact that in several recent years the British dairy farmer has received less for his milk and the consumer has paid more for it than in almost any country in Europe. That means that the system is not working as it should. We are now in direct competition with the rest of Europe. We are not taking the top part of the market, we are only 86 per cent. self-sufficient in butter fat, and we are still producing butter for intervention. That shows that changes in our dairy system are overdue.

I welcome the Milk Marketing Board's move. It initiated that move and is putting forward proposals. I was pleased to hear some Opposition Members say that the Government should not decide how milk should be marketed. I agree. I want the industry to publish an effective plan for marketing. I hope that it will do so and

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that the plan will receive industry-wide acceptance. I also hope that it will be accepted by the Community because of course the Commission also has a part to play.

The hon. Member for Antrim, North (Rev. Ian Paisley) is always a breath of air--I will not say a breath of fresh air--on these subjects. He and I have crossed swords in the past, but on this occasion I should like to pray him in aid--if I may use that term. I hope that he will defend me against the allegation by the hon. Member for Caerphilly that I have a leaning towards spiritism. I do not use the word "spiritualism", for reasons that the House will immediately see. It is spiritism that the Opposition are after. Although the hon. Member for Antrim, North may disagree with my Catholic views, I am a darned sight nearer to him on the subject than I am to Mr. Icke and the Opposition. That is about the first time that I have been able to find a religious way of getting nearer to the hon. Member for Antrim, North, although I doubt whether he will wish to advertise the fact in the north of Ireland.

We cannot usefully do anything to reform the CAP unless we ensure that the other European countries face up to the problem of fraud. People in this country will not accept a state of affairs in which they feel that they are being ripped off by large numbers of people operating in other countries. I am pleased that many countries are beginning to accept that and that there is now a considerable move to follow British advice and the British example.

My hon. Friend the Member for Dorset, West (Sir J. Spicer) talked about pollution, and I hope that he will be happy with the points that I made on that.

My hon. Friend the Member for Meriden (Mr. Mills) talked about the problems of the green pound and I remind him that we are committed to alignment in one step and not the three steps proposed.

My hon. Friend the Member for Ludlow (Mr. Gill) and others referred to the repatriation of agricultural policy, and I shall address that question directly in the last few moments available to me. I must say to my hon. Friends the Members for Ludlow and for Congleton (Mrs. Winterton) that repatriation is not a practical proposition : it will not happen ; no member of the Community will support it. Moreover, I do not think that it would achieve the end my hon. Friends seek. Repatriation of agricultural policy is proposed on the basis that one could have an agricultural policy fitted in reasonably well with other national agricultural policies in a world of surplus. But if we do not argue things out within the CAP we shall have to argue them out somewhere else. Otherwise, countries will fight them out. We may give extra support to one sector only to be countered by a French move to give extra support to another. Deals that we may do to protect our agriculture will be countered by deals done by the Germans to protect theirs. In those circumstances, the repatriation of agricultural policy would lead to more difficulties rather than fewer and we should end up with less of a level playing field. Many of our farmers would also find that countries with large farming communities--for example, Greece, with 23 per cent.--would have more pressure placed on their Governments than could be brought to bear in Britain, Denmark, Holland and France. To those hon. Members who support our agriculture, I must say that it would not do our industry any good to propose what cannot be and what would not, in any case, improve the position.

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My hon. Friend the Member for Congleton is right that we must face up honestly to the need fundamentally to change the CAP. It is all very well for the Labour party to talk about the CAP, to blame the Government and to say how much better things could have been. The fact is that all the changes that have been made in favour of a more sensible CAP have been made at the instigation of the British Government. My right hon. Friend the Member for Westmorland and Lonsdale (Mr. Jopling), in particular, led us towards major changes. It is not true that stabilisers have not worked. What has happened is that they have not worked sufficiently because we have not been prepared to take them as they should have been taken or to take the necessary compensatory measures. That is what we now have to do, and I am pressing for such action.

We all want a healthy agricultural community because only in that way can we look after our rural areas and countryside, protect our landscape and be sure of our food supplies. I am not one of those who believe that surplus is necessarily endemic. I do not believe that, in 20 years' time, the Minister of Agriculture, Fisheries and Food will inevitably be trying to deal with surpluses. All sorts of changes may take place and we may again need more production in Europe and in Britain. It is for that reason above all that we need to ensure that our food supplies are protected, our landscape is cared for and our people can rely on a healthy rural economy. Question put and agreed to.

Resolved,

That this House takes note of European Community Documents Nos. 5032/91 ADD1, ADD2 and ADD3 COR1 relating to prices for agricultural products and related measures (1991/92), 4549/91 relating to the development and future of the Common Agricultural Policy, and the Court of Auditors' Special Report No. 2/90 on the management and control of export refunds ; and supports the Government's intention to seek a price settlement that respects budgetary discipline and is consistent with the agricultural guideline, and to negotiate for further changes to the Common Agricultural Policy that make it more market-orientated, reduce its costs, lead to greater integration between agricultural and environmental policies and apply fairly throughout the Community.

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London Ambulance Service

Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Kirkhope.]

10 pm

Mr. Nigel Spearing (Newham, South) : I am grateful for the opportunity to raise the subject of the London ambulance service, but I do so with no enthusiasm because the debate should never have had to take place. One would hope that the need for ambulance services, their obvious priority and the lack of party difference on how they should be run would make such a debate unnecessary. Alas, for a number of reasons--not the fault of the Labour party--the debate has become necessary. Indeed, it is the sixth debate on the London ambulance service since 1986.

In 1965 such a debate would have been held across the floor of West Ham or East Ham town hall by ward councillors, and after that in the committee rooms of the Greater London council. It is a measure of the centralisation to which ordinary people and hon. Members are now subject that I have had to ask for this debate.

The Minister may have been told that I and some of my hon. Friends have declined invitations to meet officers and members of the London ambulance board, so I will tell him and the House why. Those people are either appointed by the Secretary of State or are employed by those appointed by him. They are not responsible for providing the resources, and they are not responsible for the policy or for the reorganisation which in effect will lead to disintegration of the service and may threaten the title of the London ambulance service itself.

That service is the largest in the world. At one time it was the world's best. Alas, that cannot be said today. The emergency service is getting less and less responsive. There are major problems in management and at headquarters, and the patient transport service, which is numerically the largest part and which transports people to out-patient departments on the medical request of clinicians and practitioners, is breaking down. Both the emergency service and the patient transport service are getting into more and more trouble. In January this year no fewer than 10,478 journeys to out -patient appointments were cancelled. That figure was in a document which, I suppose, came out of the back of a photocopier. That is what happens when centralisation and secrecy abound in government. Such a document would have been a routine report in a local council.

The effect of the cancellations, let alone the number of journeys delayed, has been disturbance, distress, dread and fear among thousands of Londoners and their families. Indeed, the concern, on-going disturbance and worse that have been caused to patients are almost unimaginable, to say nothing of the difficulties caused to those responsible for the work in hospitals who may be accused of lack of efficiency or performance.

It is no secret that Members of Parliament and councillors have received hundreds of letters. Newspaper columns have been full of complaints. The correspondence columns of the Newham Recorder, my local newspaper, have been full of such letters for two weeks. Community health councils throughout London have had meetings about the problem and are very concerned. The CHC in Newham has just published an excellent report which contains four pages of typical complaints. An elderly cancer patient had an ambulance booked for a follow-up

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appointment but it failed to arrive. When transport was contacted to book a second ambulance for a rearranged appointment, the patient was told

"If you can walk out to the ambulance, we can't send one." Due to lack of transport the patient had to cancel the second appointment, too.

That is relatively mild compared to many of the distressing problems that have occurred. For example, an item in my local newspaper said that a lady of 86 in an invalid chair had to wait six hours before she could go home after an appointment. Her husband, who is also disabled, was wondering where she was. I received a letter this morning from a lady suffering from Parkinson's disease. She can hardly walk but had to wait four and a half hours to get home. She wrote that she was "bewildered" by what seems to have come over our national health service.

One might wonder how we could have come to such a pass without warning, but there have been warnings. In an Adjournment debate on 31 October 1986, I pointed out that there had been a drop of 40 per cent. in patient transport journeys. The then Under-Secretary of State, the hon. Member for Derbyshire, South (Mrs. Currie), who is well known, said :

"I am more than happy at that development."--[ Official Report, 31 October 1986 ; Vol. 103, c. 666.]

In other words, it was a deliberate policy--a policy to reduce the budget.

I have received a letter from Mr. Harris, the chairman of the London Ambulance Board. He said that the budget had to be reduced by 3.5 per cent. --£280,000--in the current year. Also, in an official letter, the board said that it wanted to keep demand at the post-dispute level. As you will recall, Mr. Speaker, understandably demand went right down.

The health service has been cost-capped for some years. From somewhere or another an arbitrary sum has been put on the London ambulance service and it has to cut its coat according to the cloth that has been provided.

Where ambulances are necessary for emergency purposes and when doctors have said they are necessary, of all our public services, surely they should be demand-led in principle. When I raised this matter in a debate on the Consolidated Fund in 1989, the then Under-Secretary of State said :

"It cannot be financed as a demand-led service such as unemployment benefit or the prescription of drugs".--[ Official Report, 20 December 1989 ; Vol. 164, c 528]

In other words, a doctor can prescribe drugs but he is not allowed to prescribe an ambulance.

It is a sorry state of affairs that affects all London. I have said that there were 10,000 broken appointments. There are 147 hospitals in the London area and I shall give the top 10 for cancellations. The Central Middlesex hospital had 516, Ealing hospital had 443, St. Ann's hospital, Haringey had 382, Newham general hospital had 374, Roehampton had 300, Tooting Beechlawn hospital had 240, St Thomas's had 229, Stanmore had 226, Wanstead had 226, and the London hospital had 221. That was in January. Will it go on in that way?

It will probably get worse on the question of criteria. A letter from Mr. James Harris to his officers said :

"ideally, with your assistance, we would restrict the use of ambulances to patients requiring a stretcher or wheelchair and to those undergoing serious treatment such as

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chemotherapy, radiotherapy, renal dialysis and for severe cardiac or respiratory problems."

A letter I have received today from Mr. Wilby, the chief executive of the London Ambulance Board, puts it rather differently. He says : "This requires ambulance services to provide suitable transport for any patient who is considered by a GP or clinician to be medically unfit to travel by other means. Ambulance transport should not therefore be provided for patients whose medical condition does not prevent them from travelling by any other means, ie. on foot, or by public or private transport."

In other words, if a clinician says that a patient needs an ambulance, a car or minicab can be provided because they count as a form of ambulance. In practice, as the lady from Newham said, anyone who can walk to an ambulance cannot have one. Such, alas, are the criteria being applied.

The problem is well known throughout the health service. Last year I read a petition from 380 members of the London ambulance service pointing out that

"the root causes of that dispute have not yet been addressed and therefore and unless and until there is a full and proper public examination of the financing, organisation and operation of the London ambulance service there remains a great and continuing risk to the health and welfare of all Londoners."--[ Official Report, 7 December 1990 ; Vol. 182, c. 565.]

I hope that the Select Committee on Health will consider that because the service is in turmoil and needs emergency treatment. More than £3 million was spent on a computer which cannot do the job. That is now the subject of legal action. About a further £3 million is to be spent on another one. It is reported that one of the senior officers or board members has some interest in that. I do not like rumour, so three weeks ago I wrote to the chairman of the board asking whether it was true. I did not think that it was, but such rumours must be put down. I have received no substantive reply, and I hope that the Minister will find out why. I should have thought that London Ambulance Board members and officers would sign a declaration of interest, thereby making such delay unnecessary.

Reorganisation is under way--alas, not to deal with the problems that I have mentioned but something which I shall deal with in a moment. Approximately 270 officers, who did not participate in the dispute or who held different views on it, were asked to reapply for their jobs or for jobs akin to what they were doing. They were told that their contracts were being changed and that there would no longer be Whitley council representation of their collective interests. You, Mr. Speaker, may recall that Mr. Speaker Whitley was the founder of the Whitley council system, which until recently helped our collective endeavours.

Fifty of those officers failed to be reappointed. I understand that they have been offered early redundancy, early retirement or the option of giving up their officer status and becoming leading ambulance men. Jobs will be held vacant for other people. If employers treat their employees like that, how will they treat the patients whom they are elected or appointed to serve? I checked with the chairman that overtime is limited to an average of two hours per person per week and he did not deny that.

Cost cutting is stopping emergency ambulances. A lady in East Ham had to wait 40 minutes for an ambulance. When it arrived, she was very poorly and died before reaching hospital. A letter of complaint was sent, but the reply said that the nearest ambulance was six depots away. That is not acceptable at 1 am on a Monday.

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There is no accountability in this £50 million service. It is a closed book to Londoners, who know little about what is going on, and even a Member of Parliament finds it difficult to obtain information. A letter from the chairman of South West Thames health authority offers a little more information, but it is not easy to follow. There are no minutes or public proceedings, and in reply to a written question on 18 December 1990 from my hon. Friend the Member for Islington, North (Mr. Corbyn), the Minister said that he did not see any merit in publishing minutes. A local authority would have to publish minutes--the right hon. Member for Finchley (Mrs. Thatcher) was keen on such practices-- and the fire service has a joint authority, so why not the ambulance service?

I think that I know why. It will not be the London ambulance service as we know it for much longer if the Government have their way. According to their infamous White Paper, it will be disintegrated, literally, into business centres. There will be some 29 different areas, because the health authorities throughout London will be able to bid for patient transport services. From 1992, other people--perhaps even other ambulance services, in Kent, Surrey or wherever--and private firms will be able to bid. The service will be divided into two broad sections. Despite the fact that the ambulance service's official literature says that handling of the patient transport service is a vital part of an ambulance person's training, the 999 emergency service will be separated from the rest. Naturally, there will be eye-catching helicopters and probably some flying squads, but there are 2,000 emergency calls a day and I am not convinced that people will be reassured.

The service is disintegrating and becoming incoherent, and the staff are under great pressure. I have described what has happened to some officers. When there was an industrial problem recently, they voted 84 to 82 for industrial action. When a legal matter arose and they went to court, they lost their case and 100 of them put in for early retirement. That shows the state of morale in the service as a result of the new form of management.

Ambulance service personnel are professional Samaritans whom we ask to do a difficult and vital job. London's sick, dying and crippled people-- particularly the elderly--and victims of accidents should not be sacrificed on the altar of the Government's view of how a public service should be run. Clearly, a sea change has been made in the way the service is being run. New management and new personnel have been appointed by the Secretary of State. The service is unaccountable to the citizens of London, other than in debates on the Floor of the House. That is quite wrong.

The corporate loyalty of staff is being destroyed, and funds are being capped in a way that causes people to move out of London to unfamiliar areas. I mentioned earlier an ambulance that was delayed for 40 minutes. That was probably because it had to be moved from another area in order to be more efficient. Cancellations are frequent and will not be helped by the reorganisation that is being carried out for different purposes.

The good Samaritan instructed the innkeeper to charge what the man needed ; he said that he should give and, if it cost more, he would give to him. I am sure that people in London are happy to pay slightly increased taxes for a service that they want. The Government do not understand what is happening, but carry their political points of view on competition and contracts into areas where they are least desirable and practical, and where

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they cause great damage. These schemes are being implemented surreptitiously--they have not been written down other than in the chairman's letter that I read a little earlier. The best comment that I can make about the Government and their schemes is a quotation from the book to which I referred a little earlier :

"Father, forgive them : for they know not what they do." 10.18 pm

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell) : I was slightly surprised to hear from the hon. Member forNewham, South (Mr. Spearing) a speech that appeared to belittle the concept of accountability as exercised across the Floor of the House. The hon. Gentleman has a reputation as a Member who is keen to see Ministers called to account at the Dispatch Box, and rightly so, for the exercise of their executive discretion, particularly in the context of the European Community. When he makes speeches on that subject, he loses no opportunity to say that the accountability mechanism which we have built up in this place over centuries is second to none. In many ways, I agree with him when he argues that point of view.

When the hon. Gentleman argued this evening about the need for an accountability mechanism for the London ambulance service, he put on a completely different hat, which does not fit him as well as the one that he is more accustomed to wearing. He must make up his mind whether the House is an effective accountability mechanism. If it is effective in the context of Europe, it is effective in the context of the London ambulance service as well.

Mr. Harry Cohen (Leyton) : So the Government are to blame.

Mr. Dorrell : The hon. Member for Newham, South was anxious to know who was accountable for what goes on in the national health service. He wanted to know about the political accountability mechanism. It is true that the NHS is accountable to the House through Ministers, and that goes for all parts of the NHS--I do not seek to duck that point. The hon. Member for Newham, South began by establishing the importance, which he hoped would be accepted on both sides of the House, of the ambulance service as part of the NHS. I am pleased to confirm the importance of an effective ambulance service in the context of emergency response and of non-emergency provision--the patient transport service. Both are an important part of the health service. Perhaps the importance of the emergency ambulance service is so obvious that it does not need to be recited. The work done by the London ambulance service during the Victoria and Cannon Street British Rail incidents recently is effective evidence of the importance of good emergency ambulance provision. The London ambulance service carries 500,000 emergency patients a year. Every one of them and their families and loved ones have good reason to be grateful for the service's effectiveness.

The importance of the emergency service is not in dispute any more than the importance of the non-emergency service. Sometimes the non-emergency service is less glamorous than the emergency provision. Non-emergency ambulance services are an important part of the totality of health provision. That does not mean that they must always be provided in the way that they have

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traditionally been provided. It does not mean that provision can be made only on the basis of a single, uniform ambulance service across London. Some form of non-emergency transport for patients who need it on the basis of clinical discretion is part of the comprehensive health service which all hon. Members want provided. The London ambulance non-emergency service carries1.7 million patients a year as a testament to the importance that health service managers attach to the non-emergency part of the service.

There is no dispute between the two sides of the House about the importance of the ambulance service. Because there is no dispute, the Government and managers of the health service have spent considerable time in recent months addressing the management issues of the London ambulance service to ensure that the service available to the people of London matches the aspirations that we all have for it. In June last year, we established a changed system of managing the London ambulance service because we believed, like the hon. Member for Newham, South, that aspects of ambulance provision in London were not as they should be and needed to be changed.

The hon. Member for Newham, South listed a catalogue of shortcomings on which he rightly wanted action to be taken ; but which structure was responsible for producing those shortcomings? It can hardly be the one that he sought to blame, as it has been in operation in full form for only a fortnight. It is therefore unlikely that it was responsible for the shortcomings, about which there is no argument.

I am proud of the fact that the Government have addressed these problems. They started in June 1990 with the establishment of the new system of managers, whom the hon. Gentleman will not see. In July 1990, those managers published a short-term business plan for 1990-91--

Mr. Spearing : A business plan?

Mr. Dorrell : Yes, a business plan. They are running an operation and, like any operation in either the public or the private sector, should and do have a commitment to using their resources effectively in the service of the people that they are there to serve. In the context of the London ambulance service, that means the patients and the people of London. The management of the service is determined to ensure that its effectiveness in the service of the patients and the people of London is improved. That is why it announced that it is improving the training for emergency crews. That is why it announced its commitment to improving the response time of emergency ambulances and the concentration of non- ambulance services on those patients who need the service most and where the priority is highest. That is also why it announced the introduction of management training for middle and senior managers, which emphasises its commitment to an effective and efficient ambulance service that will improve on and address precisely the problems that the hon. Gentleman enumerated. The hon. Gentleman then talked about the changes that were introduced earlier this April and the effect of the new national health service arrangements on ambulance provision in London. From April of this year, the responsibility for the budgets of the non-emergency

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ambulance provision in London rests, as the hon. Gentleman rightly said, with the district health authorities. For the first year, the district health authorities will use those budgets to buy non-emergency ambulance services from the London ambulance service. However, from April next year, we should be able to see the district health authorities using those resources more flexibly to ensure that some of the shortcomings of the non-emergency service which the hon. Gentleman listed are addressed.

We shall be able to look at the relative priorities of non-emergency ambulance provision against the other priorities of a local health service in any particular district. The existing management system of the London ambulance service does not allow us to do that. We shall also be able to look at alternative ways of providing non-emergency ambulance provision for the people of London, including voluntary car services and alternative providers which may be able to provide the service at a lower cost or a higher quality of service at the same cost.

We shall also be able to address--indeed, we are already doing this--the issue which the hon. Gentleman rightly identified as one of the shortcomings of the traditional system of management in the London ambulance service. I refer to the number of journey cancellations. The hon. Gentleman quoted the statistics and knows that the National Audit Office has picked up on that issue and has emphasised that it needs to be addressed. The new management of the ambulance service is determined to see that that problem is addressed.

Turning to the emergency ambulance provision, the new system in the health service since 1 April maintains a centralised contract, negotiated on behalf of the four regions, which means that there is a unified emergency ambulance provision across the whole of London which is managed as an emergency service should be managed--with the priority being placed on effective provision of high-quality emergency care at short notice. Some of the most exciting developments in the London ambulance service relate to emergency ambulance provision. We are investing--not without difficulty--in improving the command and control of the ambulance service to improved response times that are not as good as they should be. We are providing cardiac defibrillators in every emergency ambulance and the staff training so that they can be used by the end of July this year. We are also providing training for ambulance staff to ensure that we have an extra 144 paramedical staff in emergency ambulances each year.

I am pleased to announce this evening that at its last meeting the South West Thames regional health authority approved an additional one-off capital allocation of £5 million for the London ambulance service. That includes £3.5 million for much needed vehicle replacement and will enable the London ambulance service to purchase 60 new accident and emergency vehicles and 60 patient transport ambulances. In addition, it will enable the London ambulance service to purchase a further nine rapid- response vehicles, bringing the total to 10--three in each division and one in the centre of London. Those rapid-response vehicles are an important part of the improvement in the emergency provision of the London ambulance service.

I do not pretend that the London ambulance service is without problems, but I vigorously reject the suggestion that the changes in management downgrade the ambulance service in any sense. They are designed

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precisely to address the problems that the hon. Gentleman is anxious to bring to the attention of the House and to which he has every reason to demand a solution, and that is what we are bringing about.

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Question put and agreed to.

Adjourned accordingly at half-past Ten o'clock.

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