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9.42 pm
The Minister of State, Scottish Office (Lord James Douglas-Hamilton): I congratulate my hon. Friend the Member for North Tayside (Mr. Walker) on his success in obtaining the debate. In response to his call for an inquiry, I may say that the Health and Safety Executive has investigated the matters fully on the basis of the evidence made available to it. The Health and Safety Executive can act only on the information it has and if Mrs. MacKenzie has further evidence that she has not yet made available, I respectfully suggest that she does so. My hon. Friend referred to the allegations of criminal activity, and again, if Mrs. MacKenzie has not already submitted all the relevant information to the procurator fiscal, I recommend that she does so.
I know that my hon. Friend has been exercised about this matter and we corresponded earlier in the year. I intend to take a few minutes to explain the role and
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Established on 1 April 1995, the Scottish Ambulance Service NHS trust provides a 24-hour national accident and emergency service for the people of Scotland. It also provides an essential non-emergency patient transport service conveying patients to and from NHS trust hospitals, clinics and day centres across the length and breadth of the country. Consuming more than £74 million of revenue per year, the trust employs around 2,900 staff, of whom about 2,500 are operational ambulance staff, officers and control personnel. Collectively, those staff will respond to nearly 500,000 emergency and urgent calls each year and make 2.5 million non-emergency patient journeys. In more than 90 per cent. of emergency cases, the ambulance will be in attendance within the appropriate target response time.
The role of accident and emergency crews has developed dramatically in recent years. In the past, their prime function was to "scoop and run", the priority being to transport the patient to a hospital as quickly as possible. For some patients the time taken to reach the hospital was simply not quick enough, and it was recognised that what was essential to the chain of survival of a patient was how long it took the first response to reach the scene of the accident or emergency. For many, that first response was not a doctor or other clinician, but an ambulance man, and it was, as a result, acknowledged that the skills and capabilities of ambulance men and women needed to be developed.
The Royal College of Surgeons and the Royal College of Physicians, along with senior consultants in accident and emergency and in other specialties, were engaged in determining what range of skills and training should be given to ambulance personnel. Representatives of the colleges and of the key specialities involved with accidents and emergencies continue to play a significant role to this day as members of the services professional advisory group, routinely influencing the scope and content of the professional training given to front-line personnel. While the speed of transfer to hospital remains of course a priority, the product of that commitment is that, nowadays, ambulance men and women are highly skilled professionals who are capable of dealing with a wide variety of medical and traumatic emergencies on which they may be called to attend.
Despite the demanding and often very stressful nature of the work, each year sees many thousands of men and women applying for a small number of positions. However, the vast majority of entrants into the ambulance service will start initially as ambulance care assistants and will, following basic training, work on non-accident and emergency services. Even at that level there are more than 100 applicants for every vacancy. The trust is generally regarded as a good employer. Within 18 months of having achieved trust status, more than 85 per cent. of staff opted voluntarily for the locally negotiated trust terms and conditions of service, which are uniquely supported by all the major trade unions involved.
The trust's newly opened national training college provides a consistently high standard of instruction for staff at all levels, from ambulance care assistants through to ambulance technicians and paramedics, up to and
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That action can often be taken at what may be described as the "macro" level. For example, my hon. Friend may care to know that the ambulance service is actively involved in a working group that I set up to investigate and report into the risks and dangers to front-line emergency personnel and how these might best be mitigated across all the emergency services so as to safeguard personnel against assault. Such action can also take the form of the counselling services that the trust provides for personnel who have had to attend on major incidents and who have themselves perhaps been traumatised as a result; or it can be in the very specific and tangible measures taken to immunise personnel against the risk of infection from patients with whom they come into contact.
It is as a good employer and in recognition of the fact that emergency ambulance crews are at risk of coming into contact with members of the public who carry infectious diseases that the trust's policy is to insist upon the mandatory vaccination of all accident and emergency ambulance staff. I would, at this point, make it absolutely clear to my hon. Friend that, because medical advice is that there is no identifiable risk, hepatitis B immunisation is not required for non-emergency patient transport staff, including ambulance care assistants. Nevertheless, as a good employer, the trust provides immunisation to all those non-emergency personnel who wish to avail themselves of the opportunity to be immunised.
My hon. Friend's constituent, Mrs. Susan MacKenzie, joined the Scottish ambulance service as a trainee part-time ambulance care assistant in February 1993. Before leaving the ambulance service training school, she elected to receive the first of a series of three injections for immunisation against hepatitis B.
Mrs. MacKenzie was subsequently employed as a part-time ambulance care assistant located at the Pitlochry ambulance station. In accordance with the protocols that existed at that time, the second and third doses were sent by the Scottish Ambulance Service occupational health service to Pitlochry ambulance station for Mrs. MacKenzie to have administered by her local general practitioner.
There is no question about the matter of the second dose, which Mrs. MacKenzie had administered to her by her local GP. Nor at any time has the Scottish Ambulance Service NHS trust taken issue with the claim made by Mrs. Mackenzie that the third dose of the vaccine was not passed on to her. Indeed, following her subsequent departure from the service, under the full and final settlement that she and her legal advisers accepted and signed, all issues raised by Mrs. Mackenzie were considered closed. As a result, there was no requirement to hold the planned industrial tribunal.
Nevertheless, notwithstanding the settlement, the chief executive of the Scottish ambulance service acknowledged that there was a deficiency in the rigour with which the occupational health service procedures had
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Indeed, it was only subsequent to Mrs. MacKenzie's dismissal that the matter of her having failed to receive the third dose of vaccine was pursued by her in a manner that enabled the claims to be properly investigated by the senior management of the trust.
In case there remains any doubt about the clinical basis for the Scottish ambulance service's policy of mandatory immunisation against hepatitis B for accident and emergency ambulance staff, and the fact that immunisation for non-emergency personnel is optional, I shall quote from the established guidance on the matter, the book "Immunisation against Infectious Diseases", published jointly by all United Kingdom Health Departments. It states:
I would also suggest that the particular incident should be kept in perspective. I mention to my hon. Friend the fact that there was and is no requirement for the service to provide immunisation against hepatitis B for personnel involved in the provision of patient transport services. That reflects a clinical recognition of the reality that the risks to such personnel of contracting the hepatitis B virus are considered to be so small as to be incalculable.
None the less, the ambulance service takes the most cautious view possible, and goes far beyond reasonable minimum precautions in offering non-emergency staff immunisation. I am very much aware of the fact that it is the view of my hon. Friend's constituent that the failure to provide her with the third injection was in effect a criminal act, and one which warranted the consideration of the procurator fiscal.
However, I remind my hon. Friend that that point was considered carefully by the Health and Safety Executive. Indeed, as the director general of the Health and Safety Executive stated clearly in the letter that my hon. Friend sent to me on 29 April:
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"The incidence of infection is not apparently greater than in the population as a whole for members of the police, ambulance, fire and rescue services. Nevertheless, there may be individuals within these occupations who are at higher risk and who should be considered for immunisation. Such a selection has to be decided locally by the Occupational Health Service or as a result of appropriate medical advice following the necessary risk assessment."
As we have heard, it is the policy of the ambulance service that immunisation against hepatitis B is mandatory for all staff on accident and emergency service duties. There is a theoretical risk that such staff may be exposed to the virus through cuts or abrasions that they could sustain when dealing, for example, with a patient bleeding heavily in a difficult environment such as a car crash. The use of gloves and safe working practices keep such risks to a minimum, but immunisation is considered an appropriate further safeguard.
"there is no evidence to support the assertion that the Scottish Ambulance Service failed to meet its responsibilities under Health and Safety Legislation in respect of Mrs. Mackenzie and therefore no case which could be put to the Procurator Fiscal."
The Scottish Ambulance Service NHS trust has accepted that, for whatever reason, Mrs. MacKenzie did not receive the third and final dose of vaccine to enable
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