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1.39 pm
Mr. John Greenway (Ryedale): First, I apologise to you, Mr. Deputy Speaker, and to the hon. Member for Scarborough and Whitby (Mr. Quinn), for not being in the Chamber at the beginning of the debate. These half-hour debates usually start on time. Given the six minutes that it takes to walk from Millbank to the Chamber, I was not able to be in my place when the debate began because of the early start.
I congratulate the hon. Gentleman on securing this debate, and on the measured way in which he raised the issue of the North Yorkshire ambulance service.
I had thought of attempting to secure a similar Adjournment debate, but I concluded that I would not do so, for reasons that I now declare. Mr. Murray Naylor, who was until recently the chairman of the trust, and who resigned as a result of the Galbraith report, is a personal friend. As the hon. Member for City of York (Mr. Bayley) will know, he is now a Conservative council councillor, and is the former chairman of the Ryedale Conservative Association.
However, it is fair, from the point of view of balance, to place on record the fact that the criticism of Mr. Naylor in the Galbraith report was small. In relation to some of the other difficulties that the health service has encountered in recent years, this problem, important though it is, is by no means on the same scale.
In my view, nothing in the report justifies Mr. Naylor's resignation. However, in resigning from the trust, he took an honourable course, and acted with great speed and integrity. I can advise the House that he did so after much soul searching about what was best for the North Yorkshire ambulance service. He felt that, as the report contained criticism of him, the right, proper and honourable thing to do was to tender his resignation, and that he did.
The Galbraith report came about as a result of a "Dispatches" programme on Channel 4. The hon. Member for Scarborough and Whitby made it clear that the report concluded that some of the most serious allegations in the programme were not justified. It is important that the House, the Minister and the people of North Yorkshire recognise that the serious allegation that response times had been deliberately manipulated was not found proven, although it was found that, in a marginal sense, they had been overestimated.
The allegation that defibrillators did not work and were not properly maintained has serious implications for the national picture. However, the Galbraith inquiry found that not to be the case, although the report implied that this is a national problem, and that defibrillator equipment should be upgraded across the ambulance service.
It was those two key allegations in the Channel 4 programme that most shocked the people of North Yorkshire, and gave rise to the greatest degree of public concern. Time does not allow an in-depth analysis of other aspects of the report, except to say that it acknowledges that the ambulance service has made substantial progress, and that considerable improvements have been made in the four years since the trust was established.
After the Channel 4 programme, I visited the two ambulance stations at Malton and Filey in my constituency. I had a completely open mind, and gave ambulance crews and staff the opportunity to say precisely what they thought: that is particularly important, given the allegations of bullying of members of staff by the former chief executive, Mr. King, who the report acknowledges had an extremely robust style of management. They told me that the trust had brought about improvements, but that issues in the report still concerned them. That is undoubtedly the case.
I conclude by making two points. First, I want to pick up on the point made by the hon. Member for Scarborough and Whitby about the future of the North Yorkshire ambulance service. It concerns me greatly that people in the NHS executive and in the Yorkshire and Humberside regional office may seize on this report and these events and use them as an excuse to merge the North Yorkshire ambulance trust with another trust, such as Humberside or West Yorkshire, or to merge all three.
I think that I can speak for my colleagues in North Yorkshire--judging from what the hon. Member for Scarborough and Whitby said, Labour Members share my view--when I say that the case has not been made for such a merger. North Yorkshire is by far and away England's largest county. I know, Mr. Deputy Speaker, that you represent a large rural area in Suffolk, but when one considers that the distance from the border with the North sea in my constituency and that of the hon. Gentleman to the most westerly part of North Yorkshire is greater than the distance from Southend to Bristol,
one can understand our concern that there would be serious logistical difficulties in forcing through a merger. There should be a proper public debate about this issue.
I do not believe that there is support for a merger in the York area. I know that it is difficult, because of his position, for the hon. Member for City of York to participate in the debate, but I am sure that he would agree with me that people in the York area, which we both represent, would be very concerned if, in spite of the problems that have been experienced, the ambulance headquarters at Skelton on the edge of York were to be closed and operations and decision making transferred to Hull or Leeds. That would be a seriously retrograde step.
The second point that I want to make is very much along the same lines. The hon. Member for Scarborough and Whitby referred to an accident on the A64, and the difficulty of the response time. The problem is that there is no ambulance station between Malton and Scarborough or Filey. It takes me 38 minutes to drive from my office, which is half a mile from the Malton ambulance station, to the next ambulance station at Filey; and that is on a good day. On a Saturday in June, July or August, when the A64 is chock-full with traffic, it takes easily an hour to do that journey. The hon. Gentleman knows what the problem is, because he lives in Scarborough.
If we are to impose on the ambulance service the 19-minute national response requirement, some regard must be given to the problems of dealing with such a huge rural area. That is the message that I received from ambulance crews. They say to me, "Mr. Greenway, it is all very well people complaining that it took 35, 40 or 45 minutes, as in one of the incidents in the Channel 4 programme, but people should try driving some of these distances in their own cars."
I am not making a plea for another ambulance station, but I hope that the Minister will study this problem and the difficulty associated with covering the area with communications systems and radios. There are several fire stations and other police premises between those ambulance stations, but there is no ambulance station between Malton and Filey or Scarborough. That is a huge distance to cover, and there are other problems in similar parts of North Yorkshire.
The Minister of State for Public Health (Ms Tessa Jowell):
I am glad to have the opportunity to respond to my hon. Friend the Member for Scarborough and Whitby (Mr. Quinn), and I congratulate him on securing a debate on a matter of such importance to his constituents. I listened carefully to him, and to the hon. Member for Ryedale (Mr. Greenway). They expressed important concerns about the North Yorkshire ambulance service trust. My hon. Friend is right to pursue his concerns with great vigour on behalf of his constituents.
My hon. Friend outlined clearly the background to the independent review and the recent report. I should like to make it clear that, although the report was commissioned and the inquiry panel established under the previous
Administration, panel members were appointed jointly with the National Health Service Executive regional office.
When it first sat, the panel amended and extended the terms of reference initially suggested for it by the trust. It is, however, important for us to look forward. We should take account of the lessons that can be learned, both in north Yorkshire and by the ambulance service regionally and throughout the country, from what was a series of disturbing incidents. What matters is the allaying of public concern--which is great, following events such as the one that we have been discussing--and the rebuilding of public confidence.
As my hon. Friend said, the independent review panel was chaired by Anne Galbraith, chair of the Newcastle Royal Victoria Infirmary and Associated Hospitals NHS trust. It was formally appointed on 25 November last year, and undertook to investigate nine of the areas of concern that were identified by the "Dispatches" programme and in other charges.
There were allegations of deliberate manipulation of response times. There was a demand for justification of the trust's decision to purchase a new control and communications system. It was alleged that the trust was in arrears with its paramedic training and reassessment programme, owing to a failure to invest in proper training; that it had failed to replace its defibrillators because of a lack of investment, and that that might have caused defibrillators to fail; and that, owing to a lack of investment in radio infrastructure, the low level of radio coverage in parts of the operational area had caused ambulances to be delayed.
It was asked whether line management relationships had affected the trust's operational effectiveness, whether non-executive directors had been kept appropriately informed, and whether the trust's approach to income generation had affected its operational effectiveness. It was also asked whether the trust had committed expenditure to public relations at the expense of operational services, and--specifically in relation to the tragic case of James Dean--whether it had applied any of the lessons that it had learned in practice.
Submissions to the review were invited from staff and former staff of the trust, the trust board and external organisations and individuals, including Members of Parliament. The panel conducted what was described as a thorough investigation of the technical and managerial issues raised by its terms of reference, and sought from the outset to gather comprehensive information about the trust's performance.
Time was spent in discussion with a wide range of individuals and groups, and consultation was undertaken with both the trust board and union representatives. The report was published in full on 3 June 1997, just over six months after the screening of "Dispatches". Having looked at the programme of work, and following meetings, the panel set about its task with commendable urgency.
Let me now deal with the criticisms of the trust that were made in the report, and inform my hon. Friend and the hon. Member for Ryedale of the action being taken in response to those criticisms. The public, after all, have a right to expect problems that have been identified to be
resolved swiftly. The North Yorkshire ambulance service is now under a new management team, which is tackling the urgent need to improve performance.
Let me make it clear that I am here to report on the findings of the review panel, and on steps taken by the NHS executive in the light of those findings. It is for public opinion, articulated by local Members of Parliament, to judge whether enough has yet been done.
In the light of today's debate, and having listened carefully to what was said by my hon. Friend and the hon. Gentleman, I shall ask the regional office to prepare a set of clear performance targets that the ambulance trust will be expected to meet. I hope that those targets will be widely disseminated, as will the extent to which they are met, as part of the important process of rebuilding public trust and confidence in the service.
A number of criticisms were made of the trust's management. The hon. Member for Ryedale referred to what was described as the harsh, arbitrary and inflexible leadership style that had had an impact on the trust's operational effectiveness. I understand that the chief executive who was the source of that complaint has now retired on grounds of ill health--that was mentioned by my hon. Friend--and that the chairman has also resigned. Indeed, I acknowledged his resignation only a few days ago.
I am told that staff consultation arrangements have been overhauled by the new management team. A number of groups of staff have been organised to review the trust's policies on such matters as disciplinary and grievance procedures, and health and safety matters. The trust plans to introduce an "investors in people" award, which we hope will ensure the effective involvement of staff in the running of the service. Staff side representatives have publicly recorded their view that morale has improved, and that the new management team is working effectively with staff. I hope that that will translate rapidly into improved performance by the service.
Many criticisms were made, and the responses to them are clearly set out in the report--to which I refer hon. Members who are interested. The public will be concerned about, for instance, the trust's alleged failure to deal separately with income generation calls and emergency calls, fearing that that may have interfered with operational efficiency. I understand that the trust acted swiftly to separate those very different types of call immediately after the "Dispatches" programme, and that careful monitoring of them is now under way. I also understand that further training has been secured for paramedics, and that two additional instructor posts are being advertised to meet future training requirements.
Let me refer to one of the gravest allegations, relating to the collection of performance statistics on ambulance response times. The review panel found no evidence of systematic falsification of results, but the panel felt that access to computer records was insufficiently controlled, and left the trust open to allegations of manipulation of the data collected. Having read the report carefully, I can confirm that view. I am told that the trust has taken steps to address the panel's concern, including the monitoring of the use of the system on a continuing basis to ensure data integrity.
In many respects, the best judges of whether the service has learnt the lessons of the James Dean case are James Dean's family, and I hope that they will be kept in close
touch with the way in which what has been learned from his tragic death is being applied in practice. The trust now has a new acting chairman and a new acting chief executive. I assure my hon. Friend that developments in the trust will be kept under the closest scrutiny by the regional office, which will also be asked to establish the performance benchmarks to which I referred earlier.
Questions were raised about concern about merger proposals. I can confirm that no formal proposals have been received by me, or by the regional office. New appointments to the trust board will, of course, follow full Nolan procedures in relation to openness.
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