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Mr. Andrew Lansley (South Cambridgeshire) (Con): This has been an excellent debate and I share in the gratitude expressed by others to my hon. Friend the Member for Meriden (Mrs. Spelman) for introducing it. It is both timely and necessary, given that, in the past three months, we have been unable to engage with the changes to our emergency services affecting our constituents. The debate has shown that Members in all parts of the House are concerned about these changes and it is right that we use our first week back at Westminster to bring our concerns to the Government's attention. I hope that Ministers have listened to those concerns, which are reflected in the motion.
My hon. Friend explained excellently and effectively the essence of the case: there is no basis in evidence for such regionalisation; in many cases, it will run risks;
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there is good evidence from within the service that it might hinder effectiveness; and there will be an essential loss of accountability or, as my hon. Friend the Member for Daventry (Mr. Boswell) put it, certainly a loss of access to those responsible for these vital services.
The Minister, whom I likehe often speaks a great deal of senseappears to have lost his grip. Perhaps he has been a Minister for too long and read too many briefs, instead of getting out there and seeing what is going on. He failed to answer the question posed by my hon. Friend the Member for Meriden. She asked him to show us the evidential basis for having fire control centres and asked whether a cost-benefit analysis had been undertaken. He said, "Oh yes, there is a cost-benefit analysis", but he has not published it and he did not show it to us. We had to wait for the hon. Member for Hayes and Harlington (John McDonnell) to tell us about the plain speaking of the regional management boards concerning the outline business case. They did not accept the case made to them: they did not believe that the claimed benefits would be delivered.
Nor did the Minister answer the question from my hon. Friend the Member for Banbury (Tony Baldry), who said that it is a question of the fire service's resilience not just after 2009, but during the intervening period. Indeed, that is true of many emergency services. We must remember the human dimension. It is all very well writing these ideas down in Whitehall, creating organograms and dealing with the maps and geography; it is when we try to put the ideas into practice and understand how the system is to be managed effectively in the intervening period by organisationsorganisations consisting of peoplethat serious problems emerge.
The hon. Member for Brent, East (Sarah Teather) introduced us to the concept of "quangocratisation"whatever that is. She argued on the one hand that voters had rejected elected regional assemblies, and on the other that the Liberal Democrats therefore think that we should move to elected regional government. That is a bizarre approach from the Liberal Democrats, as usual. I am afraid that, once the right hon. Member for Greenwich and Woolwich (Mr. Raynsford) stopped digging himself into a hole, he rather confused me. He appeared to argue that big is better, and that the London fire control system is the biggest and therefore the best. He left to one side the relative resources deployed in London in comparison with the rest of the country, to which my hon. Friend the Member for Forest of Dean (Mr. Harper) rightly referred. When choosing examples of where the best technology was located, the right hon. Gentleman did not mention London, but Norfolk and Merseyside. If those two areas can lead the way in the application of new technologies, why cannot a smaller service be relied on to deliver the appropriate technology?
The fact is that the Government do not want to support more accessible and accountable services that mesh attention to local need and local partnerships with the application of best technology. Rather, as my hon. Friend the Member for Hemel Hempstead (Mike Penning) said, they want to make substantial
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savings, which they probably erroneously believe can be realised from economies of scale in the regionalisation of control centres.
Mr. Raynsford: Will the hon. Gentleman tell the House whether, in delivering public services, his party believes that it is right to look for the most cost-effective means while at the same time maintaining the highest standards of service to the public? If he does not accept that, will he explain why not?
Mr. Lansley: Of course we believe in cost-effectiveness and value for money, but two points need to be made. First, the Minister has not presented any evidence to demonstrate cost-effectiveness. Secondly, as I was arguing, the Government are prepared to cut costs in order to redirect money elsewhere. That is not wrong in itself. Spending money on fire prevention will indeed save lives. However, as my hon. Friend the Member for Hemel Hempstead rightly pointed out, those who work in the fire service today want to be able to respond to 999 calls effectively and they want to develop and structure their service in a way that is responsive to local needs. If regionalisation cuts costs but reduces effectiveness, it does not provide value for money. That is the key point.
My hon. Friend the Member for Daventry provided an almost impossibly large amount of information about the geography of his constituency and where he lives, but we entirely understood his point that it is all very well being at the centre of England, but it does not necessarily prevent one from being at everyone's boundary. The idea that by having fewer bodies we have fewer boundaries has been mentioned several times. Let us go to the absurd length of considering a service that is fully national in all respects. That might be said to mean that there were no boundaries, that everything was seamless and that all services would run at maximum effectivenessbut we know that that is nonsense. The real issue is determining the proper degree of rationalisation necessary to deliver effectiveness.
Only a few hon. Members referred to the ambulance service, but it is a key issue. The Minister who is to reply to the debate knows that the Peter Bradley review was published earlier this year. She also knows that it suggested that some rationalisation was necessary to deliver a degree of strategic capacity for some ambulance services.
Let us consider the Avon, Gloucester and Wiltshire ambulance services, for example. My hon. Friend the Member for North Wiltshire (Mr. Gray) mentioned that the Wiltshire ambulance service was felt to be too small to be able to deliver the necessary strategic capacity. My hon. Friend the Member for Windsor (Adam Afriyie) made a similar point about the Royal Berkshire ambulance service. Notwithstanding its three-star status, it was felt that it needed to be run on a Thames valley basis to deliver the requisite strategic capacity. In
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neither of those instances and not at all in the Bradley review, was there any argument that the rationalisation of ambulance services needed to reduce them to as few as 11 trusts. On the basis of the Bradley review, we would be looking at about 25 trusts. Many of the relevant trusts are at the top of the star ratings, to which the Government attach so much importance: they are three-star trusts serving relatively small populations of about 1 million to 2 million.
A good argument can be made in some cases, but the problem arises if we move away from ambulance service trusts of about that size. What do we move to? The hon. Member for Brent, East mentioned the key point about ambulance services: they will be much less capable of integrating with emergency care networks. There is a whole agenda within the NHS of turning ambulance services into emergency care trusts that are capableif the local emergency care networks or the primary care trusts wish to commission themof delivering out-of-hours services. They are certainly capable of being first-response organisations. Ambulance services may even take over provider functions if PCTs are required to give them up. Any regional ambulance service would resemble the London service, which is not moving towards such innovations. It would be much less able to create the local partnerships that are so necessary and could not be managed in a way that would ensure integrated emergency care, because its standards would be set centrally.
If big were beautiful, the London ambulance service would be the best in the country. I have the greatest respect for its personnel, who responded magnificently on 7 July. However, they know, as do we, that the London service does not attain the same high standards achieved by other services. The question of how a service responds to calls was at the centre of the Bradley review, which showed that the London service was substantially less rigorous than many others. Moreover, its control centre does not have the computer-aided despatch process that other services enjoy. There is therefore no basis for the Government's proposals for the ambulance services.
In addition, the Minister failed to recognise an especially glaring anomaly. He said that the police service proposals were not set in stone and that any change would be service-led and based on open consultation. In contrast, with the ambulance service, we have not even got as far as public consultation on regional control centres, yet the Government have already decided that there will be 11 ambulance trusts. No evidence has been offered to show why that would be desirable and I know of no public support for the proposals. The people in the service to whom I have spoken believe that the proposals are driven entirely by the Government's cost-saving agenda. They do not believe that that is justified, nor expect the savings to be achieved.
I do not wish to embarrass the hon. Member for Hayes and Harlington, but he was able to answer a question posed by my hon. Friend the Member for Meriden that the Minister avoided. He said that the outline business case in respect of fire control centres was not supported by the available evidence and that documentation in his possession showed that the proposal was not supported by the regional management boards of the fire service.
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It is not good enough for the Minister to say that he will write to the hon. Gentleman and place his letter in the Library of the House. He should have published months ago the cost-benefit analysis and outline business case that underlie the Government's proposals so that they could be subject to public scrutiny.
This has been a vital debate and I am glad that we have had it. It equips all of us with the ability to tell our constituents that we have challenged the Government but, more importantly, it has exposed the Government's failure to explain why they want to go down the path of regionalisation. The Government have been frustrated by the result of the assembly elections in the north-east, but nevertheless wish to proceed with the regionalisation of government. However, that regional government will remain under the control of the ODPM and central Government.
This Government have been in office too long and have forgotten that they are responsible to the people of this country. Instead, and one way or another, they want to run all the services in this country from Whitehall.
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