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12 Feb 1997 : Column 302

Ambulance Services (Pembrokeshire)

12.59 pm

Mr. Nick Ainger (Pembroke): I have requested this debate today because, although the Pembrokeshire ambulance service operating as part of the Pembrokeshire national health service trust offers an excellent, cost-efficient, fast and effective service to the people of Pembrokeshire, that service is under threat for the second time in the space of a year.

Last summer, the Welsh Ambulance Policy Advisory Group--WAPAG--consisting of the chairmen and chief executives of each of the Welsh ambulance trusts, proposed a reconfiguration of ambulance services in Wales, forming three new health trusts. It was proposed that the whole of Dyfed Powys and Morgannwg health authority areas be covered by one ambulance trust--the Mid and West Wales ambulance trust--that north Wales be covered by another, and south Wales by a third. The existing trusts were to be dissolved and replaced by the new trusts in April 1997. The proposed Mid and West Wales ambulance trust would cover a geographical area of 1.2 million hectares and a population of 976,000, and would have a road length of more than 16,000 km.

A massive campaign was organised in Pembrokeshire by Unison in the ambulance service, by the community health council, by town and community councils, and by local representatives of all political parties. This morning, I welcome some 27 people from all over Pembrokeshire, who represent town and community councils, and Unison representing the ambulance service. They have collected more than 60,000 signatures in a petition opposing the abolition of the Pembrokeshire ambulance service. I shall present that petition on the Floor of the House tonight.

Following the campaign and the objections to the proposal from the Pembrokeshire NHS trust and SEWAT--the South and East Wales NHS ambulance trust--it appeared that the plans for centralisation of ambulance services in Wales had been quietly dropped. The people of Pembrokeshire breathed a sigh of relief--but that was not the end of the story.

In the guise of evaluating the response of the eight-minute Orcon standard, WAPAG produced in December a project initiation document, the objectives of which included looking again at the configuration of ambulance services in Wales. The document states:


that is, the Welsh Office Minister who is on the Treasury Bench today. WAPAG intends to submit joint proposals to the Welsh Office by June 1997, with a view to public consultation in autumn 1997 and introduction of the new trust arrangements in April 1998.

My main concern is that those proposals will again involve the abolition of the Pembrokeshire ambulance service. The prediction is that WAPAG will produce a report stating that there should be one ambulance service for the whole of Wales, possibly managed as three divisions--in other words, a rehash of the original WAPAG proposal for three ambulance trusts, but under a single Welsh badge. That could be, quite literally, a tragedy for Pembrokeshire and for the rest of Wales.

Part of the proposal is to evaluate a single ambulance control for Wales, but that would remove the tremendous advantages that come from having local ambulance

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controls, such as the ambulance control in Pembrokeshire, which is based at Withybush general hospital. A centralised management system with central control lacks the flexibility to respond to a range of incidents, including major events in remote parts of Wales such as Pembrokeshire.

Even if control and management were in a divisional tier--for example, if it were based at Swansea--in the event of a major incident at one of the oil refineries at Milford Haven, incident control could be established only when the major incident team had collected a major incident vehicle and driven the 60 miles from Swansea, arriving up to an hour and half after the notification of the start of the incident. By that time, without an incident control assessing the on-site risk, the first local crews to reach the scene could have been seriously injured through being dispatched into a dangerous area with no prior on-site assessment. That happened on board the Pointsman--a tanker on which there was a series of explosions resulting in deaths in 1984 at Milford docks.

That problem could be overcome by operating in the same manner as the fire service, with local divisional offices, five of which would be needed to man a 24-hour, seven-days-a-week rota in Pembrokeshire alone; but that would add at least £100,000 to ambulance service costs in Pembrokeshire, thus wiping out any marginal savings from centralised control and management of the ambulance service. On an all-Wales basis, using the unitary authority areas, that would mean additional costs of at least £1.2 million.

The local control considerably expedites the emergency response, which is even more vital now that all British Telecom 999 services come from Cardiff, and the control staff are regularly faced with misdirected calls, or have to interpret the whereabouts of visitors who have no local knowledge.

On a day-to-day level, there are significant advantages to local control within the district general hospital. It gives the hospital advance warning of building pressures as emergency work levels rise; enables discharges within an hour that are required to free beds for incoming emergencies; and saves £150,000 per year compared to manning a separate control, a hospital switchboard and community nurse communication system.

Throughout peak periods during the past two years, Withybush was the only hospital in the south Wales corridor to continue to admit emergency cases. At no time did the accident and emergency department based at Withybush hospital have to close its doors--unlike every other accident and emergency department in district general hospitals in south and west Wales, all of which have had to close at some time during the past two years.

The ambulance service in Pembrokeshire benefits enormously from the commitment of its staff and from a modern standardised specialist fleet carrying the equipment necessary to tackle the sort of emergencies faced in the area; but that was not always so. In the early 1980s, when the service returned to Pembrokeshire, it inherited a dilapidated and rundown fleet and disheartened staff who had no clear sense of identity with the service. Now the staff have built a team spirit and developed a range of specialist new skills and services.

Ambulance personnel have been integrated into the cliff rescue teams that are situated around the Pembrokeshire coastline, and the commitment of the staff is such that all

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the training and exercises involved have been carried out in their own time and at no cost to the NHS trust. Those taking part in paramedic training have also put in many hours of unpaid overtime.

There is a danger that that sort of dedication would quickly evaporate in a large ambulance trust with no sense of identity and serving many different hospitals. A medical priority dispatch service has also been introduced, enabling ambulance staff to give assistance over the phone that will help to save lives. Pembrokeshire ambulance service has consistently met Orcon standards, which are traditionally very difficult for a rural service to achieve. Again, that is down to the commitment of the management and staff.

Remote management of ambulance services on an all-Wales basis, or through the three-trust model, would reinforce the technical needs of the service for digitised geographical information systems, computerised ambulance location systems and computer-aided dispatch systems. For a large central control, those typically cost approximately £500,000 per system, and their performance has been patchy to say the least, especially in the mountainous terrain that covers most of Wales. With local knowledge, good relations between ambulance crews and control and good working systems between local doctors, hospital consultants and the ambulance service, the public get a better service, without the need for such expensive technology.

The proposal to create either one or three large ambulance trusts clearly poses a threat to the quality of the service in Pembrokeshire and the rest of Wales, but it is also likely to lead to large cost increases. The document prepared by WAPAG for the Welsh Office last year, which attempted to justify the merger of ambulance services in Wales, compared the unit cost incurred by the Pembrokeshire ambulance service with forecast equivalent figures for the proposed Mid and West Wales ambulance trust. Out of five areas performance-costed, the present arrangements under the Pembrokeshire NHS trust were found to be substantially cheaper per unit in three categories, and only marginally more expensive in the other two, than the estimated cost for the proposed new ambulance trust.

The cost of every 999 call attended would rocket from £230.72 now in Pembrokeshire to £265.29 under the proposed Mid and West Wales trust. The cost of the ambulance service per head of population would increase from £11.66 to £12.59, and the cost of each medical services staff member would increase from £32,317 to £38,776.

The Pembrokeshire ambulance service is recognised as a local service. The proposed changes cannot be justified on the grounds of cost or benefit to patients; the only motivation is to tackle the disaster that is SEWAT--a complete failure, because it was too big, inefficient and failed patients--but one does not solve a problem like SEWAT by creating what is potentially an even bigger disaster.

Obviously, that is not a reason to disband a highly effective service which has local knowledge and the expertise to deal with the types of incidents likely to arise in Pembrokeshire, or a good enough reason to throw away the advantages of the relationships that have been built up between the ambulance service, the hospitals and the doctors in the trust.

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The Minister has expressed his support for the WAPAG review, both to the group and in a written answer to me. The project initiation document dated 3 December 1996 states:


of State


    "for Health",

and the Minister told me in his written answer:


    "I welcome the work being undertaken by the Welsh ambulance policy advisory group."--[Official Report, 28 January 1997; Vol. 289, c. 159.]

However, in encouraging WAPAG in that project, he is supporting further moves away from local control of the health service in Wales, promised by the Conservative party before the last general election.

In April 1996, the number of health authorities in Wales was reduced from eight to five, with Pembrokeshire losing its health authority. The Pembrokeshire health authority was swallowed up by the huge Dyfed Powys health authority, covering half the surface of Wales. Control and influence has been removed from local areas to faceless management in distant locations. Any centralisation of ambulance services will further strain people's identity with their supposedly local health service.

Given the considerable advantages of the locally based Pembrokeshire service, in which other hospital trusts have expressed a great deal of interest, WAPAG should now ensure that the benefits of the Pembrokeshire model are fully evaluated, with a view to applying them throughout Wales, instead of choosing a huge, centralised single trust, or the three-trust model, both of which will be costly and may lead to a deterioration in the quality of service provided, not only in Pembrokeshire but throughout Wales.

My hon. Friend the Member for Cardiff, West (Mr. Morgan), who visited Withybush general hospital last year and saw the control arrangements for the ambulance service, and who will in the next few weeks take up ministerial responsibilities for health in Wales under a new Labour Government, has assured me that he will ensure that any review of the ambulance service in Wales closely examines the locally based model that has been so successful in Pembrokeshire. I urge the Minister now, in the last days of his Government, to give a similar assurance, and remove from the Pembrokeshire ambulance service the threat that he has, until today, encouraged and supported.

My hon. Friend the Member for Ceredigion and Pembroke, North (Mr. Dafis) also wants to make a contribution, and I now conclude my remarks; but I remind the Minister that the health service in Pembrokeshire was a major issue in the 1992 general election campaign, and I am sure that his responses today will be part of the forthcoming general election campaign.


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