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Ambulance Trust Mergers
11 am
Mr. Geoffrey Clifton-Brown (Cotswold) (Con): I thank you, Mr. Deputy Speaker, for allowing me the opportunity to discuss the merger of the Gloucestershire ambulance trust with Wiltshire and Avon ambulance trusts. It is causing great anxiety in Gloucestershire and I am grateful to the Minister for being here to reply to the debate, as I am for the support of my near neighbour and good colleague, my hon. Friend the Member for Tewkesbury (Mr. Robertson).
I shall set the scene. Gloucestershire ambulance trust has a two-star rating and some of its innovative measures are among the best in the country. Yet, it has been proposed to merge the trust with two failing adjoining ambulance trusts: those of Avon and of Wiltshire. If people doubt that fact, they have only to look at the response time figures provided by the NHS. In the most recent year for which figures are available, Gloucestershire is consistently in the 94 to 95 per cent. range in response to category A and category B calls, whereas Wiltshire has only a 84.9 per cent. response time and the figure for Avon is a disastrous 66.4 per cent.
So why ruin one of the most innovative ambulance trusts in the country and merge it with two failing trusts? The inevitable result of such action will be a fall in service for the people of Gloucestershire. They pay their taxes and they are entitled, at one of the most vulnerable points in their life, to service. If someone is lying beside the road, dying from a motor accident, or is in his home with liver failure or a suspected heart attack, the one thing that that person wants is a quick ambulance response. The merger will inevitably slow down that response and many people think that it is a prelude to replacing ambulances with cars driven by one paramedic. One paramedic in a car responding to an emergency cannot perform the same service as an entire ambulance team.
It is abundantly clear to me that the proposal is massively unpopular with the people of Gloucestershire. As I have said, the service currently enjoys a two-star rating and those working for it see no advantage whatever in being combined with the Avon and Wiltshire services, which have been classified as "failing" by the Government. Under the misdirection of the Government, the Avon, Gloucestershire and Wiltshire strategic health authority is seemingly willing to denigrate the Gloucestershire ambulance service and place the Wiltshire ambulance service under Bristol control, all for the measly aim of saving money. The SHA has had a miserable record. Its deficit of £100 million is one of the biggest in the country. It has had no fewer than three chief executives in the short time that it has been in existence, yet the Government, having formed that SHA, now want to do the same with our ambulance trusts. Even the chief executive of the SHA told a newspaper that the proposed ambulance merger is about "reducing overheads".
We must not be taken in by such silken tones. The damage to the ambulance services in the south-west will be not only qualitative but financial. The record of the Government in wasting public resources by reorganisation is well proven. I say to the Minister in
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good faith that each reorganisation costs a great deal of money and usually results in a worse service for us—the public, the taxpayers who pay for that service.
While desperately trying to cut monetary corners, the SHA will in fact be sacrificing millions of pounds' worth of investment. The huge financial commitment to the Devizes call centre and to the brand new Quedgeley call centre, which was delivered at a cost to Gloucestershire council tax payers of some £6.5 million and which is about to be stripped of its fire service role because the Government want to regionalise fire services, is to be wantonly abandoned and those call centres are to be left as empty testimonies to the Government's disregard for the public purse. I understand that there is a 30-year break clause in the agreement at Quedgeley, so perhaps the Minister can tell us how much it will cost the ambulance service to break that agreement.
Mr. Laurence Robertson (Tewkesbury) (Con): I congratulate my hon. Friend on raising this important matter. He will be aware—perhaps he will come to this—that we face a similar problem with regard to the fire and rescue service. I am sure that he will tell us how new the building at Quedgeley is, because what we are discussing represents an enormous waste of money.
Mr. Clifton-Brown : My hon. Friend raises a good point. We have been to the tri-service centre and seen it working. We have seen the superb telephone operation that the people of Gloucestershire now have. The close co-operation between the three services—police, fire and ambulance—is benefiting the people of Gloucestershire. The Government's initiative was a good one, but they are about to tear it up, even though it has been going for only 18 months. That is ridiculous. What a waste of £6.5 million of public money to tear it all up, take the fire service away and regionalise it, and now propose to take the ambulance service away. My hon. Friend is exactly right.
The painfully apparent lack of any firm business case from the SHA for the merger has rightly led the Gloucestershire county council health overview and scrutiny committee to call for an impact assessment to be carried out urgently, before the plan is rushed through with little regard for the consequences. At the very least, the Minister should satisfy himself with a robust business case that the plan makes sense. He owes it to the people of Gloucestershire to demonstrate that they will receive a better service as a result of the merger. If they will not, why take away a service that works?
The SHA was content to turn to Adrian Lucas, of the Scottish ambulance service, who is no doubt a very able man, but who surely has little experience of the particular local circumstances and conditions that the Gloucestershire ambulance service faces. His answer was that emergency calls from Gloucestershire should be answered from Bath or Chippenham, but how can an emergency call being answered from Bath or Chippenham help my constituents or even those of my hon. Friend in the most rural areas of the north Cotswolds? I do not think that the Minister has any idea, and I invite him to come and look for himself. Some of my constituents live 30 miles from the nearest district general hospital. If they do not have a proper ambulance service when they need it, they will die. There is no question about that. We must be sure that the
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merger will work; otherwise, we are putting people's lives at risk. I say that to the Minister in the starkest possible terms.
Regardless of how technically advanced the variety of global positioning systems may be in modern ambulances, modern technology cannot replace the knowledge of local drivers. They know the conditions and the traffic variations. That is particularly important in the Cotswolds in summer, when the roads in a place such as Bourton-on-the-Water are chock-a-block. A local ambulance driver will know how to get round the jams, but someone from Bristol, Avon or wherever else will not have that local knowledge.
One can envisage what might occur. I shall give the Minister an example. During the last Christmas break, a single telephone fault crippled the local GP out-of-hours service and, in an instant, threw an extra burden on to the ambulance service. The very thought of a similar fault occurring in a joint services call centre that might be responsible for some 2.2 million people and of all its possible consequences is awful.
Moreover, it seems that the reduction in call centre capabilities is being quietly mirrored by a reduction in the resources awarded to our hard-working ambulance crews, even to the degree that the SHA is taking away ambulances and replacing them with cars. The threat to replace ambulances in rural areas with meagre car response units—essentially, a paramedic and a first-aid kit, rather than the panoply of medical services and expertise that arrives when a fully equipped ambulance pulls up—is testimony to how little attention is being paid to the essential needs of patients in Gloucestershire. It is self-evident that one paramedic cannot provide as good a service as a trained team of ambulance men.
I turn to some of the innovative measures that the Gloucestershire ambulance trust is pioneering. It is one of the country's leaders in some of the new treatments. For example, in pre-hospital thrombolysis treatment, modern IT enables the electronic kit to be attached to somebody's body and the information to be transmitted to a specialist sitting in a hospital, who can then see exactly what phase the heart is in and administer the drug at precisely the right time. That saves lives. Not only does it save lives, but it is an example of how people might be kept out of hospital, thereby saving the NHS even more money. An efficient ambulance can treat people on the spot. They do not necessarily have to go to hospital; it might be more suitable for them to go into a nursing home, or even to stay in their own home with proper treatment from an occupational nurse.
Running down the ambulance service makes no sense. Apart from the pre-hospital thrombolysis initiative, the Gloucestershire ambulance service is one of the most innovative in the country in forming partnerships with other first-responder groups, such as the fire brigade. Indeed, the protocol with the St. John Ambulance brigade was so good that that brigade is now using it nationally. The Gloucestershire ambulance service has been awarded 120 auto-external defibrilators. That was the second largest award by the British Heart Foundation, and it went to one of the smallest ambulance trusts. The Gloucestershire ambulance trust is one of the most innovative trusts, and it provides one of the best services in the country, yet the Government want to merge it with two failing ambulance trusts. What on earth sense can that make?
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As my hon. Friend the Member for Tewkesbury knows, those who work for the ambulance service in Gloucestershire are very proud of it; they are proud to see it performing so well. If the merger goes ahead, and they see the quality of the service that they are able to offer falling, they will leave and go to the private sector, and that will have a knock-on effect.
The ambulance service can be the bridge between people and the NHS, and it can help to keep people out of hospital. However, even these peerless ambulance staff cannot be expected to provide a faultless service if they are not given the tools that they need to do the job. The tragic accident involving Mr. and Mrs. Jones and Ms Moran late last month that resulted in one fatality shows the price that will inevitably be paid when ambulances are not properly supplied in a timely fashion, but one must also look at the success stories, such as that of Mrs. Stevenson and her son Zak. They were given the highest level of care and attention by the ambulance crew and connected staff when little Zak began to experience breathing problems and had to be rushed to hospital in the most dire winter conditions, which made some roads impassable. It was primarily due to the Gloucestershire ambulance crew's local knowledge of alternative routes that Zak reached hospital in good time and was successfully treated and allowed to make a full recovery. Such local knowledge would simply not be available under the proposed merger; ambulances could be manned by paramedics from many miles away who have little first-hand knowledge of their immediate environment of a maze of twisting country lanes.
The Conservative party has stood up for the interests of local people against a burgeoning and blind, centrally led bureaucracy. Local Conservatives, under Councillor Barry Dare, called for a motion urging the strategic health authority to carry out a proper consultation before adopting the merger plans. The need for such a consultation and the blatant risks of not listening to the concerns of local people and ambulance crews were so apparent that Councillor Dare's motion received cross-party support.
Unabashed by their total humiliation in the north-east referendum that threatened to abolish the county of Northumberland, this Government, aided by the Liberals, are determined to pursue their unpopular European-style regional agenda and abolish our county services by stealth. As my hon. Friend emphasised, we have seen that they want to regionalise our fire service. Now the ambulance service is to be merged with failing neighbouring ambulance trusts. Similar plans for our police cannot be far behind.
I have something to say to the Minister: my constituents, my hon. Friend's constituents and the people of Gloucestershire pay their taxes to this Government in ever increasing amounts. They get a very good service at present. If it deteriorates, I will hold the Government to account.
11.15 am
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman) : I congratulate the hon. Member for Cotswold (Mr. Clifton-Brown) on securing
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the debate and on his interest in his ambulance service. Equally, I congratulate the hon. Member for Tewkesbury (Mr. Robertson) and my hon. Friend the Member for Stroud (Mr. Drew), who are present today.
I must say to the hon. Member for Cotswold that that was the first time that I have heard a Eurosceptic argument imposed on a discussion on ambulance services. I counsel him, in the interests of his constituents, not to over-egg his argument by suggesting that decisions have been made and that firm proposals are on the table when that is absolutely not the case.
The hon. Gentleman talked about his Conservative colleague on the county council putting down a motion calling for a thorough consultation. The only thing that is currently on the table is a proposal to consult on the matter. It is ridiculous to suggest that that has come about because a Conservative county councillor has decided to make party politics out of the issue. The SHA's proposal is to consult—nothing else, at this stage. I will ensure that his comments are seen as part of that consultation.
Dr. Ladyman : Let me make some points first. The hon. Gentleman had 15 minutes and turned what could have been a constructive debate about the future of his ambulance service into a party political diatribe. So, I think that I am entitled to make some progress before I give way to him.
The staff of the national health service in the hon. Gentleman's county and elsewhere are working extremely hard to provide better services for everybody; that includes those who must make difficult management decisions about the structures of such services. They want to engage in constructive dialogue with local populations about how best to achieve that. It does not help anybody if attempts to have such a dialogue are undermined by people saying that decisions have already been made, when, palpably, they have not.
Before I discuss the local ambulance service, I should say something about the national ambulance service, because the hon. Gentleman accused us of certain strategies which do not exist and have not been implemented. We recognise that the ambulance service provides the first point of access to health care for a wide variety of patients. It is the most important contact for more than 5 million 999 callers every year.
Far from running down the ambulance service nationally, the Government are committed to it. On top of its base funding, we have put in £50 million since 1999—providing £21 million for additional front-line ambulance staff. Money has been provided for purchasing vehicles; £3.4 million has gone to enabling services to equip front-line ambulance vehicles with state-of-the-art satellite navigation; and £10 million has been provided to purchase ambulance equipment for heart patients.
This Government are not trying to run down the ambulance service; we are committed to it. That is why we set a standard that at least 75 per cent. of 999 calls from patients with immediate life-threatening conditions should have an ambulance respond within eight minutes. In 2001, less than 71 per cent. of those calls were responded to within eight minutes, but during
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the past year performance against that standard has exceeded 75 per cent. Now, 98 per cent. of patients are overwhelmingly satisfied with the care that they receive from their ambulance service.
That sort of commitment and those sorts of targets apply equally to the hon. Gentleman's constituents as to mine. Just because somebody lives in a rural area does not mean that the Government's target of reaching them within a particular time is any less of a commitment than elsewhere. Indeed, it is necessary to recognise the issues of rurality and deal with them appropriately, to ensure that we meet the targets.
A demonstrable improvement in patient care is being achieved. In many areas of the country, including the hon. Gentleman's, innovative work and attempts to modernise are taking place. For example, there are now 400 emergency care practitioners treating patients at the scene, which avoids people having to go to accident and emergency unnecessarily. I am sure that in his calmer moments the hon. Gentleman would like to congratulate all those people on their contributions rather than launching into an attack on their motivation, which is what came across to me from his comments.
Although progress has been made, we can do even better. That is why we appointed Peter Bradley to lead a strategic review of ambulance service delivery. It will consider how to make longer-term improvements in areas such as ambulance service staff education and training, clinical indicators and outcome measures. It is also expected to resolve issues such as how best to clarify clock start/stop times to ensure the transparent and consistent measurement of response times.
The hon. Gentleman raised the issue of local services. As he said, Avon, Gloucestershire and Wiltshire strategic health authority has three ambulance services: the Avon Ambulance Service NHS Trust, the Gloucestershire Ambulance Service NHS Trust and the Wiltshire Ambulance Service NHS Trust. Gloucestershire and Wiltshire are two of the smallest ambulance trusts in England. The management of such local ambulance services is a matter for the local health economy—not for me or other Ministers sitting in Whitehall. For exactly the reasons that the hon. Gentleman gave, I have no knowledge or experience whatever of conditions in the Cotswolds. I cannot possibly know what conditions are like in his constituency; I have enough to do making sure that I understand conditions in my own constituency. That is why it is important to allow decisions to be made by local people who know about the traffic in the summer in Cotswolds villages and about the conditions on local roads, and who understand the issues of rurality. It is not for me, the Government or the Secretary of the State to impose any model on the hon. Gentleman's local ambulance service; it is for the people charged with responsibility for those services in his area to make the decisions.
It is right and appropriate for strategic health authorities and commissioners to examine the provision of ambulance services in their area and to consider whether the current arrangements could be improved to benefit patients and staff, reduce duplication and improve efficiency. That is what is happening now. In April 2004, the Avon, Gloucestershire and Wiltshire strategic health authority embarked on a project to consider how emergency services in Wiltshire could be
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better shaped to meet the demands of the future. Many factors will have prompted the authority to initiate that project, including rising demand for ambulance services and the fact that ambulance performance was identified in the Department's annual review with the authority as an issue that needed to be addressed.
Although the project initially focused primarily on Wiltshire, it also provided an opportunity to address the future role of services in Avon, Gloucestershire and Wiltshire as a whole. Two clear stages governed the development of the work. First, there was the need to develop and agree a service framework that enabled ambulance services to make a more effective contribution to unscheduled care. For example, the project considered how staff in new roles, such as the emergency care practitioners whom I mentioned earlier, could be best utilised. That is particularly important for rural communities such as those in Avon, Gloucestershire and Wiltshire. ECPs have the skills to treat patients at the scene of an accident, which can help to avoid the need to travel to A and E. Secondly, there was the need to consider the best organisational arrangements in which to implement the service framework.
Once a rationale for the review had been established, three options emerged: the creation of an integrated management team across the three organisations, a merger into a single organisation and the status quo. The current situation is that Avon, Gloucestershire and Wiltshire strategic health authority has decided to commission an independent organisation to undertake a detailed benefits analysis and risk assessment of those options. The recommendations of that analysis should be presented to a steering group of chairs and chief executives from the three trusts and their lead commissioners, together with the SHA. That is exactly the business plan that the hon. Gentleman asked me to ensure would exist before any decisions were made.
Mr. Clifton-Brown : The Minister's last comment was very helpful. To ensure that we get something useful out of the debate, will he assure us that the people of Gloucestershire will be given every opportunity to contribute to that study, that they will have plenty of time to do so and that the study will genuinely take their views into account? The Minister has given the impression that the failure of the Wiltshire and Avon ambulance trusts is all that this is about, and that is exactly the fear of the people of Gloucestershire, who get such a good service at the moment.
Dr. Ladyman : I have steadfastly tried to avoid saying that that is the primary reason for the review. It is my belief that the SHA sees potential benefits to considering the three organisations together. Each of the three organisations and everyone throughout the area, including the people of Gloucestershire, will benefit, and the perceived problem of underperformance in Wiltshire will also be dealt with. I promise the hon. Gentleman that his constituents will be included in the consultation. It is clear from having talked to the SHA and having studied the matter since realising that the hon. Gentleman had secured this debate that the SHA intends to have a wide-ranging and thorough consultation with everyone before any decisions are taken.
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I stress again that this is an objective exercise. There are no hidden agendas or predetermined outcomes. Nothing in the process should worry the hon. Gentleman, his constituents or any other hon. Member in the Chamber. Indeed, there is much for them to gain. Since 1974, mergers and reorganisations have reduced ambulance services from about 100 to 31 trusts, and there is a general trend towards fewer, larger ambulance trusts. For example, Shropshire merged with the West Midlands ambulance service, and three ambulance trusts merged to form Tees, East and North Yorkshire Ambulance Trust. There are significant gains to be made for each ambulance service as a result. The potential benefits for the hon. Gentleman's constituents are there to be seen, and it is foolish to close our eyes to the possibility of those benefits.
Mr. Laurence Robertson : The Minister is talking about other ambulance trusts that have merged, but in an answer to my parliamentary question, the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), said:
"We are not aware of any other SHAs and their constituent organisations formally considering this issue."—[Official Report, House of Commons, 31 January 2005; Vol. 430 c. 741W.]
Dr. Ladyman : I am referring to ambulance trusts that have already decided formally to review their structures and to merge. I confess that I do not recollect that question offhand—unfortunately, I do not remember every question that I sign—but I shall be happy to answer it if the hon. Gentleman writes to me with his query. Faster response times, reduced bureaucracy and other such issues are all potential gains for all the constituents of all the Members in the Chamber today.
NHS bodies have an absolutely clear duty to consult on these matters. The Government and the Secretary of State make that clear. We do not want to be put in the
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position of taking any decisions at the centre about mergers or reconfiguration. We want those matters to be sorted out locally by local people.
I know that the hon. Member for Cotswold is not the only Member interested in this issue. the hon. Member for Tewkesbury has asked parliamentary questions about it, and my hon. Friends the Members for Stroud, for Forest of Dean (Diana Organ) and for Gloucester (Mr. Dhanda) have already met my hon. Friend the Member for Doncaster, Central (Ms Winterton), who leads on ambulances issues for the Government. They have already expressed their concerns, so all Members who represent the area have started to engage in the process. It is very important that all Members do so.
It is also very important that the hon. Member for Cotswold ensures that the opinion of every one of his constituents is listened to. I fully support him in that, and I am happy to meet him and to discuss the matter in the Chamber as necessary so long as he understands that, at the end of the day, the decision is for local people, not me. I want local people to produce the best strategy for themselves and to decide how best to improve services throughout the area and not only in one part of it. That will ensure that he and all his constituents are satisfied that there will be gains for them and for others in the area from any decision that is eventually taken. The status quo is still an option, as is rationalising the management organisation rather than an outright merger of the three trusts. However, we can ensure that constituents' views are taken into account only if we all engage constructively in the debate.
I conclude by thanking the hon. Gentleman once again for securing the debate, but I ask him not to give the impression that decisions have been taken when clearly they have not. These are matters for local people to engage in.
11.30 am
Sitting suspended until Two o'clock.
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