Examination of Witnesses (Questions 940
- 959)
WEDNESDAY 17 APRIL 2002
MR GRON
ROBERTS OBE AND
MR PETER
BRADLEY
Syd Rapson
940. Can I say, first of all, I represent Portsmouth,
as Mike does, and certainly I am very proud of the Hampshire Ambulance
Service, no less than Essex and London. They have met all their
targets against these plans in the budget and the morale of staff
and in the South East where house prices are phenomenal, how they
get fire, ambulance and policeman to work, I do not know. The
Ambulance Service is certainly excellent. I want to go into the
co-ordination of the Ambulance Service as one of the blue light
services. Certainly you have to have robust arrangements to work
with the police and fire service and under the Ambulance Service
Association memorandum it describes the Ambulance Service supporting
the Government proposals to encourage all three blue light services
to develop more common approaches, joint training and operational
procedures. Are you satisfied that co-ordination and co-operation
arrangements between the three of you are adequate at all levels?
(Mr Roberts) No, it would be very complacent of us
if we were to claim that, I think. This Association and the two
professional police and fire ones were party to a three presidents
report which actually looked at what services could do better
together. That report is currently with ministers. Ministers have
asked us to bring them some more concrete examples, the radio
system is one of them. We do work fairly closely together on a
day to day basis now anyway and that is why I think the issue
of representation is so important. If we really are partners then
partnership does not have to be equal but there has to be some
equality in it. What we were finding was that police and fire
were very, very well represented, they were both in the Home Office,
although fire is now DTLR, and we tended to be the poor relations
coming along at the back. I think professionally, as three heads
of professional services, my colleagues in police and fire and
I are working very closely together but we need the national doctrine,
the national agreements and we need to push them down. At the
end of the day it comes down to individual people, avoiding turf
wars down in Hampshire or anywhere else, and generally I think
we are working quite well. There are some raw sensitivities, I
think it would be daft to say there were not.
941. The Ambulance Service itself has expressed
its full commitment to working better with the other services?
You have done that, there is no doubt about it.
(Mr Roberts) Yes.
942. The memorandum again goes on about representation.
It states in particular "In return . . . for this commitment
. . . the Ambulance Service would expect . . . " and this
is what you are asking for—give me, give me—"
. . . equal representation on all relevant committees and national
working groups so that our views can be directly considered in
the same way as our partners". What in particular is it that
is worrying about representation where you are not adequately
represented or you feel you are taking a lesser share in the decision
making? Can you put your finger on it? Am I being a bit too fussy?
(Mr Roberts) I suspect there are two dimensions. Outside
health the Cabinet Office started to get very proactive in terms
of cross Government issues. If you look at the Cabinet Office,
they have got police secondment, they have got fire secondment,
they have got nobody from the Ambulance Service. Therefore, either
we tend to go by default or people guess for us and I think then
we end up doing damage limitation jobs or running to catch up,
quite frankly, if we have got a partnership that is not acceptable
to the service. Within the health service I think there is an
issue about ambulance and health, it is a bit like saying "Well,
the fire service is a part of local government". People say
because they have consulted health that embraces ambulance. We
are an integral part of the NHS, we do not want to be anything
else, but we are a different part in many ways from the hospital
end and from the public health end. Therefore, trying to get somebody
who can represent all three sometimes means one of us falls off
the end and usually it is the Ambulance Service. We are quite
keen internally, within the Department of Health, to make sure
that we are there when the decisions are made and a cross Government
that our voice is there when decisions are made.
943. You talk about the NHS for yourself and
local government for the fire service and the police have got
their own police bodies. Are they in any way a hindrance to your
co-ordination of the services: the bureaucratic monsters out there
that we talk about sometimes without a knowledge? Is that a hindrance
to you, is that holding you back? Can you arrange the co-ordination
and the procedures between you and overcome their reluctance to
merge as much as you are doing?
(Mr Roberts) Locally I think we do not have a problem,
it is about individual chief officers and the general relationship
at operational level is fine. I think it is at the policy making
more strategic level.
944. That is Government level you are talking
about?
(Mr Roberts) Yes, generally.
945. County or regional level you would work
it out yourselves.
(Mr Roberts) Yes.
Chairman
946. In any local exercises are you fully integrated
in the process of emergency planning at town level or city level
or county level?
(Mr Roberts) Yes.
947. You have no anxiety?
(Mr Roberts) No. Funding is the anxiety.
948. Of course.
(Mr Roberts) And the value you get from these exercises
sometimes versus the cost. If you look at ambulance services,
everybody now wants exercises and one ambulance service probably
covers a fair number of local authorities, there will be an airport
or two, there will be British Rail, Railtrack, they all want exercises
and nobody wants to pay.
Mr Cran
949. Gentlemen, would it be correct if the Committee
started from the proposition that the Ambulance Service really
has a considerable knowledge of dealing with terrorist incidents
or would it be more correct to say that some of the ambulance
services in the country have that expertise?
(Mr Roberts) The latter. Some ambulance services have
significant experience in dealing with incidents, not the type
of terrorism that maybe is chemical and biological but certainly
they have a lot of experience in dealing with the other types.
London in particular probably has more experience than anybody
in the world in dealing with major incidents of various kinds.
950. I ask the question from the standpoint
that, as I have said on a number of occasions in this hearing,
I am no terrorist but if I wish to have an incident in the United
Kingdom, I am not sure I would wish to choose London simply for
the very reasons you two have given, I would wish to choose another
of the major cities. Now in answer to a question from Mr Hancock
you touched on London but what about the other major cities: Leeds,
Manchester, Edinburgh, Glasgow and so on? In other words, just
whilst you are thinking, if there was a major incident such as
11 September in one of these cities, could the Ambulance Service
deal with it?
(Mr Roberts) If there was an incident like 11 September
in any city in the UK we would struggle to deal with it. In some
ways from a health point of view if you get a large number of
people dead then it is still a major incident but the problems
it presents to us are very different from, let us say, the sarin
attack in 1996 in Tokyo where you have got lots of live casualties,
they have all got respiratory distress, they are panicking, all
our plans are premised on the fact that we can corral people in
a way, we can hold them there and deal with it at the scene. If
it is going to take us 40 minutes to get there, they are not going
to be there by the time we get there, not if they have got any
common sense. I think 11 September changed our thinking fundamentally
about the risk side. In terms of day to day major incidents, most
ambulance services have got significant experience. In terms of
terrorism, London, Manchester, and a few other cities have had
some kind of incident, usually with warning, usually with time
to prepare and places have been evacuated, and again that would
have been very different from 11 September. Almost every ambulance
service will have been responding on a fairly regular basis over
the past 20 years to suspected parcels, this, that and the other
but none of us is up to speed or resourced to deal with things
like 11 September.
951. It really is a very serious statement that
you have made, highly critical of all the structures around you
that provide the resources so you do your job properly. I get
the impression as I go through this inquiry that in the good,
old British way there is a great deal of calm, commonsense being
spoken but underneath all of that I am not sure I see a great
deal of really meaningful action. Therefore what I want to hear
from the two of you, and I am in no way critical of you, of course,
is that very, very, very stern representations are being made
to those who provide the resources to solve the problem. You have
already said, if there were a major attack in, let's say, Glasgow
of the type in New York, you would struggle badly. What other
representations have there been and who is saying no?
(Mr Roberts) I would like to make it very clear that
if I am sounding critical of the infrastructure, I do not mean
to be. At the end of the day, what happened on 11 September is
that it changed all our planning assumptions. Our planning assumptions
up to then were about major incidents. We do not deal with natural
disasters in this country which cause thousands of casualties
and go on for weeks, we generally tend to have short, sharp, major
incidents, a couple of hundred casualties dealt with in four hours.
So I do not think I imply any criticism that we were not better
prepared. Certainly I think for chemical incidents we ought to
have been better prepared and we are now. So those are the things
which are positively happening. What we need is time. We cannot
get our preparations up to speed for 11 September-type incidents,
even if we had all the money in the world, in the short term.
There has been no civil defence in this country since the 1960's,
so there are logistical issues about where we get the staff from
and so on. We are making strong representations, but I am not
sure that 11 September is a particularly good example, from where
I sit anyway, of the type of incident we would be planning for.
It is the probability and the risk I think that is an issue.
952. Are you one of those, and is the Ambulance
Service as an institution one of those, who says, "11 September
was a very exceptional event, it is probably not likely to happen
again and therefore what we are going to do is plan on the basis
of opportunity cost, what is the likelihood that the same thing
will recur", which really does mean, does it not, you discount
an awful lot of the possible threats which might come along? Is
that the approach of the Ambulance Service?
(Mr Roberts) I would not go quite that far. The reality
is we spend the money rather than make it. I think someone has
to take decisions about how far you go in terms of those national
risk assessments.
953. Are those around you who provide the resources
putting that pressure on you to say, "Hey, of course to meet
every eventuality we could come up with a figure, but because
that might not be affordable or whatever we have to go for something
less and therefore scale down all the possible threats"?
Are those the pressures on you?
(Mr Roberts) No, I have not been aware of any pressures
as such. I am not sure where that debate would take place. This
is about a national risk assessment and a consequence of that
risk assessment would be the funding issue. As far as I understand
it, every spending department has been asked to ensure preparedness
is built in, and it is a question really for ministers as to how
much they want to spend on that.
954. And you are putting maximum pressure on?
(Mr Roberts) We are certainly saying—
955. And you have costed it?
(Mr Roberts) No, we have not. We have not costed anything
except the chemical protection equipment and decontamination equipment.
There is a piece of work which needs to be done to say, "What
would a good response to a 11 September incident look like?"
The lessons from New York are not even here yet, and with all
their resources—and I was over there when the World Trade
Centre was blown up the first time—how well did they really
cope with it? How could we have done it differently? There has
to be some scenario where you say, "There are planning limits",
because if you go into these incidents which are so broad, they
just become so difficult, people give up and say, "We cannot
do anything about it anyway." I think it is about striking
a balance personally.
956. The Committee would be interested in knowing
how the operational procedures for dealing with the victims of
a terrorist attack differ from those of a major incident or a
natural disaster? Are they the same or different?
(Mr Roberts) Broadly the same. We start from an all-risks,
all-hazards approach to emergency planning and consequence management
whatever the cause. However, there would be some differences.
If there are security differences, if there are chemicals or biological
agents involved then you have added complications, but the basic
tasks, which are about rescue, about assessment and then definitive
treatments, are broadly the same.
957. So there is an easy transfer of expertise
and knowledge?
(Mr Roberts) Yes, I think so.
958. The Committee would be interested in knowing
whether the armed services have a capability that you could and
do draw upon. We take the view that the Army Medical Services
probably are not much help to you, but are other elements of the
armed services? Would they be of use in these sort of incidents?
(Mr Roberts) Our planning assumption, what we have
been told, is that we should not assume the Army can lend us any
support. They may well be fully engaged in dealing with their
own problems. There are arrangements in place for Military Aid
to Civil Authorities but our planning assumptions are that anything
we get from the military would be a bonus. Clearly in detection,
which is one of the big issues, what are we dealing with, the
experience and expertise of the military is going to be very important.
Chairman
959. It depends how long they take to get to
you. Your guys and girls would reach an incident fairly quickly
and, without the training, could blunder into a crisis not knowing
it was something they had never personally experienced, or even
read or been instructed about. With the best will in the world,
it could take hours before the small number of units which are
capable are driven to you—hopefully not up the M6 at 5 o'clock
on a Friday afternoon but helicoptered—so what happens in
the meantime? That is a grave worry. Then you find what you are
dealing with is a chemical or biological attack. You would obviously
spot a nuclear attack but not necessarily a chemical or biological
one, or some appallingly communicable disease.
(Mr Roberts) I agree, Chairman. We rely on other people
to do the detection. We do not have any detection equipment, the
police and fire might have some. We would be very reliant on their
advice in terms of whether we go in or not. The protection of
our initially-attending crews is a critical issue for us because
we envisage—although the national doctrine might come out
different—trained teams for chemical and biological attacks
rather than trying to train everybody, because that would be very
difficult to do.
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