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Mr. David Heath (Somerton and Frome): Does the Minister recognise that apart from the response time for an ambulance to arrive at the scene of an incident, a further problem in the west country is the distance to accident and emergency units, which are widely dispersed in rural areas such as the south-west? It takes a long time for an ambulance to get to a hospital, so there is a double bind for the patient.
Mr. Denham: I am not sure whether the hon. Gentleman was listening to what I said. What he says is a fact of geography. I was setting out the measures that are or could be in hand to enable the ambulance service to deploy its resources most effectively to the patients in most urgent need.
The NHS executive intends to issue a health services circular in March outlining our approach to category C pilots in more detail. The circular will require ambulance services to register all category C pilots with the
executive. It will also stress the need for careful evaluation of the pilots before any decision is taken to change the current system, which enjoys huge public confidence.
Early indications are that many of the pilots will include linking appropriate category C calls into NHS Direct, which seems sensible. Any request from the West Country Ambulance Services NHS trust to register a category C pilot will be considered carefully by the NHS executive. Before such schemes are introduced, health authorities and the ambulance service will be advised to have locally agreed procedures and standards in place for dealing with minor emergencies. The pilots, as well as those procedures and standards, would need to be supported by the professions, take account of local concerns in the community and be properly explained to the public.
The second initiative that will have an effect on ambulance response times is that from April this year, the ambulance trust, in co-operation with local NHS trusts and general practitioner co-operatives, will be providing NHS Direct across the four health authorities in the south-west. NHS Direct is a major element in our efforts to use new technology and better information systems to provide faster care more conveniently. By the millennium, NHS Direct will cover up to 60 per cent. of the population in England.
Evidence from our pilots so far is that there is a great potential for the new service to assist in the handling of category C calls. It is also likely to help to avoid the clogging up of the 999 system, lessen the growing work load of GPs and reduce pressures on hard-working accident and emergency departments. If that potential is realised, it will enable the ambulance trust to concentrate on the more serious calls and thus improve response times.
It will be a challenge for the trust to achieve the new ambulance response standard, which requires that from 2000-01, 75 per cent. of category A--life-threatening--999 calls must be responded to within eight minutes. The trust has commissioned an independent review of the service from Operational Research in Health, in agreement with health authorities in Devon and Somerset. The report will review the current use of resources and establish the base line for achieving the new performance targets by 2000-01. It will then be for health authorities to develop plans to meet the targets and to ensure that the new standards for ambulance response times are met.
The hon. Member for South-East Cornwall called for additional Government funding for the health authorities in the west country. He said that he believed that the process whereby money is allocated to individual health authorities does not take into account the cost of providing health services in a rural area, particularly given the geography of the south-west peninsula.
I shall, therefore, say a few words about the way in which health authority money is allocated. I remind the House that the background to this is the investment in the health service of £21 billion over the comprehensive spending review period--a sum substantially greater than that envisaged by the Liberal Democrats.
Mr. Andrew George (St. Ives)
rose--
Mr. Denham:
I will aim to give way if time allows, but first I must respond to a number of points.
The Department of Health uses a national weighted capitation formula as the basis for allocating hospital and community health services revenue to individual health authorities. The underlying principle of the formula is to distribute resources as equitably as possible, based on the health care needs of the residents of the various health authority areas.
Weighted capitation targets are not fixed in time, but are recalculated annually to determine each health authority's relative share of the overall resources that we make available to the NHS. Changes to the targets of individual health authorities are usually the result of routine updating to take advantage of the latest available data, such as population figures or boundary changes.
The weighted capitation formula has been reviewed. Last year we made four changes to it. The one most relevant to this debate was the introduction of a geographical cost adjustment for emergency ambulance services. That arose from an exercise to examine the effects of rural sparsity on the cost of providing certain services. Although a geographical cost difference was found for emergency ambulance services, no such difference was found in the cost of providing accident and emergency services in hospitals or patient transport services.
The resource allocation group recommended that we introduce an adjustment to reflect the costs of emergency ambulance services, which we have done. The new advisory committee on resource allocation has agreed that issues of rurality and cost should be part of its longer-term work programme.
The target figures that have come out of the formula are intended to provide a fair and equitable share of NHS resources for each health authority. It is important to point out that each of the health authorities that commissions ambulance services from the West Country Ambulance Services NHS trust currently receives more than its target allocation.
In 1999-2000, the hon. Gentleman's health authority, Cornwall and the Isles of Scilly, will receive nearly £6.5 million more than the formula would indicate is its fair share of NHS funding. Other health authorities in the region are in a similar position--North and East Devon will receive £5.4 million more than its target, Somerset more than £2.9 million, and South and West Devon an extra £7 million.
I am aware that Cornwall and the Isles of Scilly health authority, where the problems in achieving the response times are most marked, is faced with particular financial difficulties, and it will develop a financial strategy that addresses its deficit. To assist the health authority during the transitional period, I recently announced a £2 million grant for the coming year from the special assistance fund to that health authority.
The hon. Gentleman spoke of his concerns about a possible European Union directive requiring a change from two-stretcher ambulances to single-stretcher
vehicles. I believe that his worries have arisen out of the work being undertaken by the European committee for standardisation, which is trying to put in place standards that are similar across the European Union, to enable fairer competition. Hon. Members will be reassured to learn that no EU directive on ambulance specifications such as the hon. Gentleman describes has been signed. Hon. Members will also be pleased to hear that the current proposals on standards being examined by the committee relate to the space requirements in emergency ambulances and will allow two-stretcher ambulances to continue to be used.
There are sound clinical reasons why some ambulance trusts in England may want to consider the adoption of single-stretcher ambulances. For example, a single paramedic might find it difficult to treat two seriously injured patients adequately at the same time. Any decision to move to the use of single-stretcher vehicles will be for individual ambulance trusts to take in the light of best clinical advice.
I have been assured that if introduced, the changes being discussed will relate only to new vehicles. There will, therefore, be no need to renew entire ambulance fleets as a result of any forthcoming directive. I am also assured that old ambulances can continue to operate until the end of their operational life, so they could be sold on to organisations such as St. John Ambulance.
If the hon. Member for St. Ives (Mr. George) is still interested, I shall give way to him now.
Mr. George:
I am grateful to the Minister. With reference to his remarks about screening emergency calls to the service, the problem in my constituency is lack of hardware, particularly for night cover. Will he comment on the number of ambulances available in rural areas, especially overnight, and the difficulty of meeting emergency response times? The target times could not be met without the support of the voluntary sector, especially the air ambulances.
Mr. Denham:
That brings us back to a central point in the debate. There is a responsibility on the trust to work with the health authorities to achieve the necessary response times. Block capital is allocated to all NHS trusts according to a set formula. The West Country Ambulance Services NHS trust receives its allocations in the same way as all other ambulance trusts. The trust bought 17 new vehicles in 1998, plans to purchase nine in the coming year and hopes to purchase 14 new vehicles in 2000.
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