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Mr. Carmichael: Will the hon. Gentleman give way?
Tom Levitt: I may give way a little later on. The hon. Gentleman and I have been restricted to 15 minutes, whereas other speakers in the debate were able to go on for nearly 20 minutes.
As a former trustee of the Royal National Institute for Deaf People, I am especially pleased that the draft disability Bill was mentioned in the Queen's Speech. In 1997, the Government set up the disability rights task
force. We then went on to establish the disability rights commission, and my hon. Friend the Member for North-East Derbyshire (Mr. Barnes) was instrumental in that long campaign. In 2001, the Government published "Towards Inclusion", their response to the report from the disability rights task force. Many of the issues addressed in "Towards Inclusion" are now in law, but outstanding issues remain that the new Bill will address. It will address transport issues and—I hope—it will give public authorities a duty to promote equality for disabled people. I also hope that it will expand the definition of disability more widely, as the hon. Member for Cheadle (Mrs. Calton) suggested, to include those with HIV and cancer.As chair of the all-party group on the voluntary sector and charities, I am especially pleased to see that the role of charities will come of age in a new charities Bill. We often see the economy as having three sectors—the public sector, the private sector and the voluntary sector. However, over the past few years, other sectors have emerged. For example, we have the compact between voluntary sector and public sector operations. Co-operatives and not-for-profit companies fit in between the voluntary sector and the private sector. Public interest companies, with a charitable purpose, will be established by another Bill and will fall between the public and private sectors. We no longer have a triangular model, but a continuum of different vehicles with different functions that work to deliver quality services in partnership with other parts of the economy.
The Bill will enable the charitable and voluntary sectors to maximise the contribution that they make to society. It will remove arbitrary restrictions on their operation, modernise the definition of "charitable purposes" and greatly benefit national voluntary sector organisations and charities, as well as the small ones with which we each work daily in our constituencies.
The future of our economy depends on investment in skills. We need more graduates. The target of 50 per cent. of 30-year-olds—not 21-year-olds—with degrees is modest compared with some countries with similar economies. We need investment and we need to generate more graduate-style jobs. We need to ensure that we are a highly skilled, highly paid economy and that we resist the temptation to fall behind and become a warehouse economy. Therefore, we rely on a healthy, vibrant higher education sector to teach students and for research.
Where should the investment come from? I hope that we have all agreed that up-front fees are dead, because they are politically difficult and there is no reason for them. The taxpayer spends about £6,000 on every university student, about £4,500 on every sixth former, about £4,000 on every secondary school pupil, about £3,000 on every primary school pupil and about £1,800 on every pre-school child. If we are serious about a long-term commitment to, and investment in, education to improve the qualifications that people achieve and to benefit the economy, we should put our investment in the early years. That would generate a more receptive generation for higher education later down the line. That is why I have no qualms about asking graduates to make a contribution to pay for what they have received. Many will not be asked to pay anything because they
will not earn enough. Nobody who earns under £15,000 a year will be asked to make a contribution. The advantage of this proposal over a graduate tax is that graduates pay a graduate tax for the rest of their life. Under our proposal, graduates will cease to pay when their debt has been repaid and it will not be a lifetime burden.Some countries are ahead of us on this matter. Australia's system for financing undergraduates and graduates could be a successful model to follow. It is essential to stress that, under a top-up system, universities should not and will not be free to choose what fees they levy, but that fees will be approved by an independent body—a regulator—and in that sense there will not be a free-for-all for universities to charge what they want.
My local university is the university of Derby and it has establishments within the High Peak constituency, in the town of Buxton. Derby is almost unique because it represents a coming together of higher and further education. I would argue that, if we are going to have deferred fees for higher education, let us have them for further education as well.
I have a constituent who, three years ago, had to give up his job as an engineer because, through meningitis, he contracted epilepsy. As a result of epilepsy he can no longer work with machinery. He wants to become a quantity surveyor—it takes all sorts, but apparently there is a great demand for quantity surveyors and there is a choice of ways of qualifying. However, he has found that the fees for that non-degree course, which he wants to take by distance learning, are higher than those that are being proposed for the highest level of fees for higher education.
There is a huge disparity between FE fees in different parts of the country and for different courses. For most people, further education is much more tied in to people's vocational experience and development than higher education is. Further education is more likely to involve working on the job and is more likely to have that vocational link to a person's earnings. It may not produce as dramatic an effect as getting a degree would, but certainly the person studying moves onwards with more qualifications. I realise that FE is a complex sector but I do ask that we look very seriously at producing the same sort of equity in FE as deferred fees will produce in higher education.
I would have liked to dwell on other elements of the Queen's Speech, but time has almost eluded me. I very much welcome the creation of a children's commissioner for England. The measures proposed on domestic violence, which accounts for a quarter of all violent crime, are also very welcome indeed. I am absolutely confident that the hunting legislation is not in the Queen's Speech simply because it is not this year's legislation but last year's unfinished business, but as unfinished business we must tackle it. It is a question of faith and I am absolutely certain that when the time comes, it will be there and it will have my support.
The measures in the Queen's Speech stand out as being sensible, appropriate, measured, practicable and necessary—and many are exciting too. I am looking forward to this Session and the legislation therein. I have great pleasure in contributing to the debate. My maiden speech was in the Queen's Speech debate in 1997, so I
have pleasure in being the one who has the privilege of bringing the first day of debate on this year's speech to a close. I hope that we shall move on quickly into the legislative programme and deliver, deliver, deliver.Debate adjourned.—[Vernon Coaker.]
Debate to be resumed tomorrow.
Mersey Ambulance Service
Motion made, and Question proposed, That this House do now adjourn.—[Vernon Coaker.]
9.59 pm
Helen Jones (Warrington, North) (Lab): I rise to express my deep concern about what is happening inside the Mersey regional ambulance service—a concern that is shared by several other hon. Members, particularly my hon. Friends the Members for St. Helens, North (Mr. Watts) and for Knowsley, North and Sefton, East (Mr. Howarth), who, along with me, have already written to the Minister about this issue.
Let me make it plain at the outset that this is not a debate about Government funding—in fact, the income base of the service has increased by 9.9 per cent. in a year, according to the most recent figures I have, and it is not underfunded for emergency care—nor is it a reflection on the front-line staff, for whom I have the greatest respect. Indeed, I agree with the Commission for Health Improvement's last report on the trust in which it said:
- "The enthusiasm of ambulance crews to deliver an efficient service to the public is remarkable."
Let us remember that it was a good trust. It was one of the first to meet the eight-minute targets for emergency responses in urban areas, for example. It is now a one-star trust, and the CHI report pointed out serious problems in its procedures and practices. For some time, hon. Members have received information from inside the trust about its management and the problems in its control room. This issue came to a head when my hon. Friend the Member for St. Helens, North and I received information that, over the weekend of 1 and 2 November, there had been serious shortfalls in ambulance provision in Warrington and St. Helens. We were not notified of that by the trust. When we started to make inquiries, the trust's response told us much about its management failings.
I tabled a question that was answered by the Parliamentary Under-Secretary of State for Health, my hon. Friend the Member for Welwyn Hatfield (Miss Johnson), on 17 November. That answer told me—I am sure that she answered in absolute good faith—that the shortfalls were due to the closure of Warrington hospital to emergency admissions. May I caution Ministers to be very careful about the information that is relayed from the trust and the SHA? I have a copy of the trust's occurrence log for that weekend. The Department of Health tells me that that log is not available centrally, but may I tell it that, as almost every newspaper in my area has a copy, it ought to obtain one?
The log runs from 7.5 on 31 October to 5.45 on 3 November, and it shows an organisation in real crisis. Shortfalls in ambulance provision kept being reported all through that weekend, the first of which occurred at 10.17 on 31 October. Other shortfalls were recorded at
16.2, and again at 20.13 and 20.24. The same thing is apparent in the records for the next day, not just in Warrington and St. Helens, but throughout the area. People called in sick. Ambulances were single-staffed or unstaffed. That was long before Warrington hospital closed its doors to all but life-threatening emergencies, which did not happen and was not recorded in the log until 18.13 on 1 November. Although the sudden surge in emergency admissions throughout the area on that day certainly exacerbated problems for the ambulance service, it was not the cause of them.Even more worrying is the way in which the trust deals with 999 calls. I asked a question about how many times the trust had been contacted by BT in the past six months to express its concern about the handling of 999 calls. In answer, I was told on 19 November that it was contacted once. If that is what the trust is telling the Department of Health, it is guilty of a gross deception, because the log clearly shows that, over that weekend, BT rang 10 times to complain about difficulties in putting through 999 calls. On one occasion, there was a delay of more than eight minutes, and on another, of nearly seven minutes. At 1.38 on 1 November, BT Newport rang the critical contact number to complain that it had a critical call that it had been unable to pass for 11 minutes. Merseyside police also rang that weekend to express their concerns that 999 ambulance calls were coming through to them, presumably because BT could not get them answered in the ambulance control room.
The trust's response is to say that it was an exceptional weekend. Sadly, that is not the case. I have an email that was sent to Mr. Jackson, the director of critical care at the trust, on 7 October. It comes from Mr. Ian Hall, who is 999 liaison manager at BT. It makes it clear that BT has been in contact with the trust for some months—and most of us would regard that as more than once—over the trust's failure to deal with 999 calls in
- "a timely manner and without undue delay".
Mr. Hall also gives some interesting figures. It appears that among 999 calls in August, 195 were not answered within two minutes. By September, the figure had gone up to 236, and the latest parliamentary answer that I have gave the figure for October as 332. The situation is getting worse, not better.
Mr. Hall's email also reflects the fact that what we saw in the log for 1 and 2 November has been happening at other times in this trust. Delays of seven and eight minutes are reported. On one occasion, when a call was not answered until seven minutes had passed, BT rang the critical contact number and was told that there was only one person in Mersey regional ambulance service available to take calls. On another occasion, when BT tried the three numbers available to it and a call was not answered after 11 minutes, it rang again and was told that the control room was very short-staffed and would be all night. It asked whether it could put through calls to a neighbouring trust, but that request was denied.
I ask my hon. Friend the Minister to investigate why that request was denied, because surely the point of an ambulance service is to get ambulances to the sick people who need them. The point is not for a trust to defend its own bailiwick. If this had been going on for months and was not being remedied despite BT's contact, we have to ask what on earth was happening.
Mr. Jackson's response to the email was to say that he would discuss it with his executive colleagues as a matter of urgency. Whatever action they took was clearly ineffective, because the problems were still occurring into November. I suggest to my hon. Friend the Minister that they will continue to occur until there are changes in the management of the trust.
The CHI report made it very clear that many staff in the trust feel devalued and vulnerable because of the way in which changes are being introduced, and it pointed to poor morale in the trust. Sadly, there is no evidence that the problems have been addressed since the report was produced. Members constantly receive reports of increased stress on staff leading to increased sickness absence. There are poor industrial relations and the number of grievances lodged is a cause for great concern. The report recorded 153 grievances lodged between April 1999 and March 2002, and a parliamentary answer given to me says that there have been 66 since then. All that speaks of a trust in which the management are not able to tackle the problems that face them, industrial relations are poor, and they are unable to manage change effectively.
What is happening in the control room is a good example. I am told that there were recently only five staff on duty there instead of 15. The number later rose to seven or eight. In response, the chief executive was quoted in one of our local newspapers as saying that the trust could not magic people up to answer calls. Of course not, but one would expect that any trust that had such a problem would be looking at the causes of the absences and doing something to tackle it. There is no evidence that that is taking place. I also ask my hon. Friend the Minister to consider seriously why two managers were moved out of the control room—as I understand it, one was moved out to do project work, while the other went on secondment—with the funding following them. What kind of system of priorities is operating in a management when a control room is short-staffed, but people and funding are taken away from it, rather than put in?
I suggest that what we are seeing is the result of a particular management style, and particularly that of the current chief executive. I think that she has shown herself to be unable to accept any form of collegiality or to respond to criticism. Let me give one example. Shortly after her appointment, the chief executive decided to reorganise the management structure. She did so without any reference to the salary and appointments committee whose remit is to review and endorse such changes. When the committee reviewed the matter, she said that the chairman and non-executive directors were acting inappropriately. Despite the fact that an internal review of the trust concluded that they had acted perfectly appropriately, and the endorsement of that conclusion by the trust's solicitors, a highly respected local firm that has acted for many parts of the health service for a good number of years, she refused to accept the conclusion. I understand that, when mentoring was offered, she turned it down.
That is a style of management that not only destroys personal relationships but has led to the introduction of procedures in an unsafe way. For example, call stacking was introduced in the control room. That is not a bad procedure in itself, but the way in which it was introduced led a manager to send an email to the director of performance saying that it was unsafe because no written protocols were in place. Instead of being treated as the whistleblowing email that it clearly was, that communication was reported to the chief executive, who promptly called in the manager and moved him from his post. What are we to make of a trust that deals with concerns about patient safety in such a cavalier fashion?
Unsurprisingly, a grievance was then lodged. During the hearing of the grievance, it emerged that another procedure, "treat and refer", had also been introduced in a very odd way. Again, there are arguments for using treat and refer, which can be a very useful procedure, but it requires proper training for paramedics and clear written protocols. The procedure was being trialled in the trust by a small group of paramedics. The chief executive unilaterally ended that trial and rolled out the procedure across the trust. I understand that there was no consultation with either the medical director or the director of clinical care, no written protocols were in place and the trust board did not approve the procedure prior to its introduction. What we have to remember is that there are patients on the receiving end of these procedures, and their safety should be the prime concern. The trust's solicitors advised that by taking such action the trust had laid itself open to an increased risk of litigation. I find that a cause for deep concern.
I also find cause for concern when I hear about what happened at the end of the grievance procedure. I understand that, before the result was announced, the papers once again passed to the trust's solicitors. They advised not only that the grievance should be upheld but that there was a prima facie case of gross misconduct against the chief executive. That was, as I understand it, never investigated. It should have rung alarm bells at the strategic health authority because I am told that its chairman had been notified of the problems with the management structure early on, and both the chairman and the chief executive were made aware of the grievance procedure's outcome and the advice of the trust's solicitors. One might have expected them to support the trust's non-executive directors when they decided—I believe properly—to call in an independent person to review what had happened with a view to possible disciplinary action against the chief executive. However, they did not do that.
The control room is in crisis, procedures are introduced without the proper protocols being in place and the solicitors are advising that a prima facie case of gross misconduct requires investigation. Instead, the chairman and chief executive of the health authority tell the trust board that it should get someone in to do what they call "board development work." If I had a suspicious nature, I would assume that they were trying to protect their friends. That is what happened. The trust brought in a lady called Pearl Brown to undertake what was effectively consultancy work. She was taken on, because there was a vacancy in the trust, through a firm that provides interim executives at £1,000 a day. Yet the chief executive constantly tells the press that the trust does not have enough money.
The board gave Pearl Brown a fairly wide remit, but I understand that most of her work focused on the relationship between the chairman and the chief executive. Nevertheless, I am told that her report concludes that the management of the trust is dysfunctional. It is not simply dysfunctional but a disaster for the front-line staff and for the patients on the receiving end. That cannot be allowed to continue.
I ask my hon. Friend the Minister to examine those points carefully. I strongly suggest that there should be a review of what happens in the trust. It should involve outside people, possibly someone who has experience in ambulance services and someone with experience in industrial relations, which are clearly disastrous there. She should examine the role that the SHA played. Did the chairman and chief executive consult their board before advising the trust? If so, what information was given and on what basis did they decide to disregard the trust's solicitors' advice, which would have been properly investigated if it applied to another employee? I make no comment on the potential outcome, but the advice would have been investigated. Those matters should be considered urgently before the words "potentially life-threatening situation" become simply "life-threatening situation". Our constituents deserve better.
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