Examination of Witnesses (Questions 920
- 939)
WEDNESDAY 17 APRIL 2002
MR GRON
ROBERTS OBE AND
MR PETER
BRADLEY
Mr Hancock
920. I am interested to know what sort of guidance
and other national guidance you have been given since 11 September
with regard to how you are going to operate in the future and
how that is being filtered down to your members who are responsible
for counter brigades etc and how that is different from what happened
prior to 11 September?
(Mr Roberts) The Health Service's emergency planning
function, as you may or may not know, is vested in the public
health chain. That is where the guidance, after 11 September,
was issued. There was a fair amount of guidance, particularly
on biological and chemical, which came out after 11 September.
Sometimes from the sharp end it felt a bit slow, from where we
were sitting, because by then particularly my colleagues in London
were already dealing with so-called white powder incidents on
a fairly regular basis. Yes, the guidance did arrive but the guidance
was slow and the mechanism for getting it out in health is a little
bit cumbersome and again we have had discussions with the Department
of Health about that, about how we might sharpen up.
921. What about resources to enable your staff,
the crews who would be called to these emergencies, what about
giving them extra training and particularly taking them off the
job for training, and that poses some problems manpower wise because
your organisation is over-stretched anyway? What is happening
about making sure that the front line element of your service
is now getting the training they need to recognise some of the
issues they will now face?
(Mr Roberts) If I talk about the general position
and perhaps ask Peter to talk specifically about London where
he is responsible. It is a little bit different in terms of London.
Ambulance services are under a great deal of pressure. The NHS
agenda for the Ambulance Service is to respond to life threatening
calls faster and in order to do that you need as many men and
women out on the road as you can so training for anything is a
problem. Our state of training pre 11 September was not very good
and post 11 September, although it has got a little bit better,
it is still a long, long way from being what we need. That is
partly because there is a cost attached, which has yet to be funded,
and partly it is because we just do not have enough staff to be
able to release people to go and do specialist training. There
are some huge issues for us in particular around staff training,
both the first crews who will go there, and need to recognise
what they are dealing with, if they are not going to become victims,
and then the more specialist crews who might need to go there
in terms of decontamination and other things.
922. How many of the shortfalls that you perceive
there are, relating to training, equipment, even ambulance crews
having to wear decontamination suits, protective clothing and
what have you, how much of that has been properly evaluated and
costed and has a bill been presented to the Civil Contingency
Secretariat for them to address and try and get extra resources
for?
(Mr Roberts) I am not sure what has been presented
to the Civil Contingency Secretariat. The Department of Health
have actually funded the cost of personal protective equipment
and decontamination equipment so there has been some capital money
from the Department of Health but it has been in the form of equipment.
It has been slow arriving. The personal protective situation before
11 September was pretty poor, they then made an interim issue
so that we did have at least some equipment available and there
is now a more definitive issue coming along which each trust will
be able to get but does not have to pay for. The big issue is
more about the revenue costs of training and maintaining. The
situation in London, as I say, after sarin in 1996, was a bit
different. Peter might want to comment.
(Mr Bradley) Just to say, we have 60 staff presently
specially trained to deal with the front end of a CBRN incident.
923. Spread over the whole of London?
(Mr Bradley) Yes, that is increasing. 24 hours, seven
days on call.
924. There are 60 fully qualified ambulance
personnel across the whole of London working on a three shift
system?
(Mr Bradley) Yes.
925. At any one time there are less than 20
at work for the whole of London?
(Mr Bradley) That is correct, yes. That is increasing
to 150 by July/August fully trained. I think the issue that Gron
Roberts raises is quite a real one. There is an issue around for
a large long term incident, it is sustainability of staff who
can stay in the field for only so long and releasing large numbers
of staff for the specialist training is very difficult. I think
the issue is to have the specialist training for a smaller number
but have the general awareness raising for the majority.
926. What about getting that equipment to an
incident? Presumably those crews are spread across London geographically.
(Mr Bradley) Yes.
927. So if you need all of them in one place,
have you estimated the procedures which would have to be adopted
to make that happen and to get the back up for that, calling people
in and getting them located? Do you think you can do that with
150 once again for the whole of London?
(Mr Bradley) I think we can. The LAS attends lots
of chemical incidents during the year. We have fairly well tuned
processes. I think where ambulance services and other emergency
services are vulnerable is on the huge incidents that could happen.
It is about what is fair and reasonable in terms of preparation
for an incident which could be protracted or could be very large.
For the day to day small or medium sized incidents the ambulance
services in London are well prepared. I think that we have, since
11 September, we have gained lots of experience in the white powder
incidents that Gron Roberts raises. We have been well able to
get all our staff trained to incidents within 45 minutes.
928. That is London.
(Mr Bradley) Yes.
929. What about the other big centres of population
then? What do you know of what is available in the other centres
around the country?
(Mr Roberts) The situation is pretty variable around
the country. As I say, I think London, because of the Sarin attack
on the underground in Tokyo, they did react much quicker. I do
not think the NHS actually woke up to the fact that CBRN was much
of an issue before 11 September. The risk assessment was low.
It has always been difficult to get intelligence sharing to allow
you to make proper risk assessments. There has been a sensitivity
and an air of secrecy about the thing which has largely reduced
now. So the situation is still variable. If you get authorities
such as Mersey, where there are large chemical complexes, their
local risk assessment would have meant they needed equipment and
they have a fair amount of it. In other, more rural parts, there
would not have been anything at all perhaps.
930. Is there a national plan which allows a
major centre like London to be reinforced by counties sending
assistance to back up? Is there a military element to that? Is
there a plan which you have been party to the construction of
which allows that to happen?
(Mr Roberts) Dealing with the military aspects, our
planning assumption is that the military may come along as a bonus
but we should not rely on any military assistance in this current
situation. As Peter says, every ambulance service on average can
expect to deal with 17 incidents a year involving chemicals, and
generally 95 per cent of them produce less than five casualties,
so we are used to going along dealing with that routinely, with
the fire service doing much of the work there anyway. I think
what 11 September taught us is if there are going to be attacks
multi-centre on that kind of scale involving particularly chemicals,
then we need to re-think our doctrine, and that is what we have
been trying to do since 11 September. Once we got over running
around dealing with white powder we, as an Association, have been
trying to reflect, and we have had a one-day seminar about what
needs to change. One of the things we are clear needs to change
is our approach to major incidents which was very locally based,
so the home service basically dealt with the incident and it only
called in support when it was needed. Particularly for a chemical
incident, any mass decontamination, we are going to have to rely
much more on a national doctrine, national standards, national
commonality of equipment, so teams from Essex can come into London
after 40, 45 minutes, take over the decontamination, because people
can only work in equipment for 30 minutes or so. So I think our
doctrine has to change and we are currently engaged in discussions
with the police and fire about producing a national doctrine,
and the training plans which need to go with that.
931. Your Association then has obviously asked
its members to look at what they possess, what they have in the
way of skills, equipment, et cetera. How common is the equipment
which is used at the present time? Have you addressed with Government
the issue of how that common factor of equipment, training, et
cetera, is going to be achieved and how it is going to be financially
achieved? Most ambulance trusts, if our experience is anything
to go by, are very stretched and do not have the resources which
are needed to accomplish an increased burden for this sort of
contingency.
(Mr Roberts) Up to now there was little commonality.
Ambulance services made decisions based on what they saw as the
level of risk, what they thought the equipment should be, what
was the best kind, what was the best kind of suit. What has happened
since 11 September is that there was some national work going
on anyway but that national work has now been accelerated, so
we are now issuing personal protective clothing to every ambulance
service which is the same. We will be issuing decontamination
equipment which is the same. The training issues and the national
doctrine are things which we have to develop, and I am actually
going down tonight to Wiltshire to a joint services meeting to
try to develop some of this doctrine, so the Association is working
hard at playing its part. I think since 11 September it would
be fair to say there is an issue about the time lag that it will
take us to get prepared, and there is also an issue about funding,
who is going to meet the cost of all of this when Mr Milburn's
objectives for the NHS are much more in-your-face than a possible
CBRN incident.
932. Is it your intention as an organisation
to submit a price tag associated with these additional requirements
you now need, and for that to be treated separately by Government,
rather than trying to squeeze the NHS for this money?
(Mr Roberts) We will try to identify for the Department
of Health very clearly what we believe to be necessary in terms
of initial and revenue costs in particular to build in the capability
and resilience that is needed. Another example would be the radio
systems, the current radio systems for police, fire and ambulance
are different.
Chairman: And going to get worse. Did
you see the Public Accounts Committee report a couple of days
ago?
Mr Hancock: It was pretty damning.
Chairman
933. The new radio system will exclude the Ambulance
Service.
(Mr Roberts) I have not read the report. What I can
say to you is that we as a professional association and the police
and fire have signed an inter-operability agreement which ministers
are looking at next Monday. The Cabinet Office have been very
active in trying to persuade us that we ought to get inter-operability
and we support that fully, but there is a cost to extra resilience
and there is a cost to inter-operability.
Mr Hancock: On the cost, it would help
us enormously if we could have some indication of what you anticipate
that cost to be. This report, hopefully, will get the Government
thinking about what they have to do and what they have to fund,
and as parliamentarians it would help us enormously if we could
then target that money and make sure they were putting that in.
If you could supply us with that figure and that list of requirements
which is not being met at the present time, then we can press
that and this report hopefully will help you.
Chairman
934. Before you leave, we will give you a copy
of the appropriate report.
(Mr Roberts) That would be very helpful.
935. It will make pretty depressing reading
as far as the Ambulance Service is concerned.
(Mr Roberts) I have to say, to be absolutely honest,
the problem we have is that we have not costed these things yet.
We are in the process of drawing up a technical specification
for what inter-operability might be like, what additional resilience
might be like and there has to be an issue about how much that
costs.
Mr Hancock
936. My final question is one which has been
prompted by what has been written in the past and that is about
the way in which the Ambulance Service nationally and locally
can handle security-sensitive information and how that is handled
and how certain staff will be privy to it and others will not.
What are the mechanisms within the Ambulance Service for dealing
with fairly sensitive information about how you respond to various
risks?
(Mr Roberts) The problem with plans is that they are
not much good unless we share them with the people who are going
to be there.
937. Absolutely.
(Mr Roberts) I would not say the Ambulance Service
as an organisation is any better or any worse at dealing with
that kind of information. We deal on a daily basis with very confidential
clinical information, very personal information, and our crews
are very, very sensitive to that. What was a problem, and it was
a problem after 11 September, was the issue about how much do
you tell the people and what happens to that when it goes into
the public domain. Keeping things secret means that nobody knows
anything anyway, and I think we and the Department of Health struggle
to get that balance right. There was a public fear/public tensions/"Let's
not say too much" attitude, on the other hand we, as professionals,
say, "Unless we know what we are dealing with, how do we
deal with it?" I still think we have to work on that balance,
to be honest.
Chairman
938. I can recall the Department of Health advertised
for a Chief Civil Emergency Planning Officer without any requirement
for a qualification in emergency planning. So I am not even certain
the Department of Health are on the right track in dealing with
these complex issues. Secondly, you have mentioned the drawing-up
of a new doctrine, at what level would that be drawn up? Would
you at a county level be involved in drawing-up that doctrine?
(Mr Roberts) I feel we, as an Association, at a national
level will need to draw that up. The point is that I do not think
it will work at a county level, there has to be a national approach
to these problems. In fact, it is much more cost effective because
it is either train everybody in London or train London to deal
with the first 45, 50 minutes, until support comes in and we know
what we are relying on. The cost of doing it everywhere would
be prohibitive. We see ourselves with the other two professional
associations, police and fire, and with our colleagues in health,
as agreeing the doctrine.
939. It will not be at Department of Health
level though, it will have to be some working group cross-cutting
different government departments.
(Mr Roberts) The first thing is that we have to establish
who is responsible for what. We have a memorandum of understanding
with the fire service about mass decontamination, which is a national
framework agreement but has to be applied locally. What the services
need to do is decide who is going to be responsible for what and
then go away and do it. A lot of the work we need to do needs
to tie in to health, the hospital end, rest centres, social services,
that type of thing. What I think we will probably do is draw up
a draft national doctrine and then try to translate that into
operational procedures and training processes with our National
Health Service colleagues. In fairness, it is not part of my brief
to defend the emergency planning function of the Department of
Health at all, but we have become much more closely linked since
11 September than we were before. There is a lot of clinical expertise
and particularly on biological where perhaps that is less of an
issue for ambulance services. We might have a role to play in
biological incidents but basically it is chemical and nuclear
which are the new dimension post 11 September and the heightened
risk of that.
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