| Previous Section | Index | Home Page |
Mr. John Burnett (Torridge and West Devon): Does my hon. Friend agree that it is impossible to reconcile 3 per cent. so-called efficiency savings with the additional burden of a 6 per cent. rise in call-outs?
Mr. Breed: That is absolutely correct. The service is expected to find 3 per cent. so-called efficiency savings, although one must consider extra burdens such as millennium compliance costs, which have fallen squarely on the authority. Staff pay accounts for 80 per cent. of trust costs. The trust is overspent on pay budgets, and therefore any deficit will have to be met from within such budgets. In order to keep within them, additional staff will not be called in when, for instance, someone is off sick. Instead, spare crew members will have to be allocated to other vehicles. That may mean that, at times, vehicles are without crews. The trust has also been forced to drop planned shift cover in order to curb overspend.
Last year, a target was set of reducing shift cover by 40 hours in each of the 11 station officer's areas. In order to eliminate overspend completely, the ambulance service would need to reduce shift cover by a further one fifth. Although reducing shift cover is the quickest way in which to compensate for the overspend, other initiatives may have to be implemented, such as a vacancy freeze, a freeze on non-clinical training and, very worryingly, slippage of some clinical training into the next financial year. None of those measures will enhance response times. Recent NHS pay awards and the implementation of the working time directive also concern the ambulance trust.
I acknowledge that the Government have allocated £100 million as part of the modernisation programme, but trust estimates show that that will account for only 0.6 per cent. of the additional funding required. For Cornwall and Isles of Scilly health authority, every 1 per cent. above the 2 per cent. inflation funding represents £41,000. That is the equivalent of one operational crew working for 40 hours a week.
Clearly, such cost-cutting exercises will not help the already overstretched service to try to meet national targets. The south-west yet again loses out under targets that are set for the entire population of the country. Targets for Cornwall have been reduced to 87 per cent.--8 per cent. lower than the national average. Just why the people of Cornwall are expected to accept lower standards has never been fully explained.
I am sure that everyone will agree that the ambulance service has a basic need for a reliable vehicle fleet. Ambulance staff already feel that the fleet is far from satisfactory. As I said earlier, some vehicles have almost 300,000 miles on the clock. Many old vehicles with such high mileage are still in frequent use. As the vehicles get older, they will inevitably be less reliable. This year, the ambulance service will need to replace 41 vehicles if its fleet is to be made up of vehicles under seven years old, but it can afford to replace only nine of them. No doubt the service will not forget that it had to replace vehicles in the not-too-distant past because their wheels were coming off.
The service must also meet the cost of warranties and maintenance for newer vehicles. According to UNISON, to which I am extremely grateful for providing information, a significant number of newer vehicles in the fleet will soon be outside their warranty period. That will mean that additional costs for repairs to those vehicles will fall on the trust rather than the supplier.
The effect of draft proposals by the committee for European normalisation--something that, I confess, I had not fully understood until recently--to standardise ambulances will also place disproportionate cost pressures on the west country ambulance service. The new regulations will involve phasing out the old two-stretcher ambulances and will effectively make it necessary to dispatch two vehicles to an incident where there are likely to be two casualties. Vehicles will, therefore, have to travel more frequently, which not only increases mileage, but reduces cover. It is important to remember that fuel consumption, which is a major cost and a great concern to the ambulance service, will rise considerably if the proposals are accepted and additional vehicles must attend incidents.
The proposals will also have a great impact on the St. John's Ambulance Brigade--the voluntary charity to which I am sure we all want to pay tribute--which supplements the ambulance service on an enormous scale. The charity purchases its vehicles, which are usually second-hand, from the ambulance trust. It is considering whether it will be able to continue to do so under the new regulations, and that is causing concern.
The plain fact is that the west country ambulance service does not have sufficient resources to meet national targets. The public have a right to expect ambulance staff to arrive on the scene of an incident as quickly as possible. The scenarios that I outlined earlier are true cases and are not isolated incidents. There is no cheap fix. If the
ambulance service is to be able to provide professional care and meet the targets specified by the Government, it must be able to afford the appropriate vehicles and provide the adequate level of staff and training.
The Minister ought to agree that, at the moment, the west country is losing out in many respects simply because the funding formula does not reflect the increased costs involved in providing that essential front-line emergency service for people living in rural areas. Our ambulance service is expected to bear those costs year in and year out for millions of tourists and the local population.
Finally, I want to remind the Minister of a fact of which I am sure he is aware, but which is often forgotten. The people of the west country fund, by voluntary contributions, two air ambulances. Week in and week out, people dedicate themselves to raising the money to keep those air ambulances going. People in Devon, Cornwall and Somerset put their hand in their pocket because they believe that it is a vital service, but people in Scotland and London benefit from air ambulances funded by the Government. That fact alone ought to mean that the Government should at least ensure that land ambulances receive all the necessary funding.
The Minister of State, Department of Health (Mr. John Denham):
I congratulate the hon. Member for South-East Cornwall (Mr. Breed) on securing this debate on a subject of such importance to his constituents and those of other hon. Members from the south-west who are present.
The Government have made it clear that high-quality care should be at the heart of the national health service. That applies to ambulance services, which provide the public and patients with round-the-clock emergency care and access to the full range of clinical services. Ambulance services are at the forefront of the modernisation programme set out in the White Paper, "The New NHS", which involves embracing new technologies to support better and faster patient care and playing an important part in the development of NHS Direct.
I share the hon. Gentleman's concerns about the inability of the West Country Ambulance Services NHS trust to meet the national standards for ambulance response times. That is a serious concern, and the local health authorities and the trust must work together to ensure that national standards are met.
I recognise the hard work and contribution of all the staff of the West Country Ambulance Services NHS trust who last year responded to nearly 90,000 emergency calls within the 19-minute target--more than ever before. In the past few years, the trust has experienced a steady rise in the number of 999 calls made to the service. Since 1993-94, the number of emergency calls has risen by over 44 per cent. to more than 105,800 last year.
Two initiatives are likely to have a major impact on the ability of the trust to deliver improved response times: criteria-based dispatch, which the hon. Gentleman mentioned, and NHS Direct. Last April, the trust introduced criteria-based dispatch, which is a method of prioritising all 999 calls into three categories: category A consists of calls about situations that are immediately life-threatening, category B calls relate to serious situations and category C calls relate to situations that are not life-threatening or serious.
By 2000-01, all ambulance trusts should have introduced call prioritisation systems and are expected to meet an interim new standard of responding to 75 per cent. of all category A calls within eight minutes. Category B and C calls should continue to be responded to within 19 minutes. Criteria-based dispatch is, therefore, an attempt to answer emergency 999 calls according to the seriousness of the patient's illness and not, as in the past, according to where they live.
I emphasise that category C calls are still included with category B calls in having to be answered within 19 minutes. Those calls make up about a quarter of the total emergency calls and the Department of Health recognises that the practice of responding to them in exactly the same way as to life-threatening emergencies needs to be carefully evaluated to ensure that valuable NHS resources are best deployed in providing first-class emergency care.
| Next Section
| Index | Home Page |