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Westminster Hall

Wednesday 29 March 2006

[Mr. Joe Benton in the Chair]

Ambulance Service (Staffordshire)

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Dhanda.]

9.30 am

Michael Fabricant (Lichfield) (Con): On a point of order, Mr. Benton. I am sorry to interrupt proceedings.

Today, a written statement is due from the Department of Health on the proposed changes to the configuration of strategic health authorities, ambulance trusts—the subject of this debate—and primary care trusts. This morning, I went to the Library and found that it has not yet been deposited. Before the end of this debate, will the Minister make that written statement available? It may have a bearing on the subject of this very debate.

Mr. Joe Benton (in the Chair): Strictly speaking, that is not a matter for the Chair. If the Minister chooses to comment, I shall allow that. However, we must proceed pretty quickly.

The Minister of State, Department of Health (Ms Rosie Winterton) : I shall certainly make inquiries about when the written statement will be placed in the Library. I shall report back to the Chamber on that.

9.31 am

Mrs. Janet Dean (Burton) (Lab): I am pleased to open today's debate under your experienced chairmanship, Mr. Benton. This opportunity to discuss the success of the Staffordshire ambulance service, and the concern of all who live in Staffordshire that our excellent service should be retained, is timely, given that last week saw the end of the consultation period on the reconfiguration of ambulance services.

During the past few months, there has been much activity aimed at ensuring that my hon. Friend the Minister and her colleagues in Government are aware of the desire of Staffordshire people to ensure that our superb service is retained. My hon. Friend the Member for Staffordshire, Moorlands (Charlotte Atkins) secured a debate on that issue in Westminster Hall in November. There have been other debates on the issue, as well as questions, early-day motions, petitions and meetings with Ministers, including the Prime Minister.

I am pleased to see so many Staffordshire Members here. I understand that the hon. Member for South Staffordshire (Sir Patrick Cormack) would have been here but for a previous engagement. My hon. Friend the Member for Stafford (Mr. Kidney) has a constituency engagement, but tells me that he spoke to Lord Warner in advance of today's debate.

Through representations and the large number of responses to the consultation, the Minister will be aware of the strength of feeling among people in Staffordshire, who believe that nothing should be done to undermine
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the first-class ambulance service that we enjoy. Indeed, we would like the achievements of Staffordshire to be echoed around the country.

Staffordshire has the best response times and resuscitation standards in the country. We also have the most economic service. Staffordshire's results are not just the best—they are outstanding. In the early 1990s, changes were made by Roger Thayne, the chief executive of the Staffordshire ambulance service. The first ambulance station proposed for closure was in Uttoxeter. That brought opposition, not least from me and other councillors. The system that was introduced positioned ambulances around the county according to the demand predicted on the basis of how the service had been used historically. However, without the introduction of community paramedic officers, piloted in Uttoxeter by Neil Phillips, such areas of the county could have had worse protection, although overall response times would have improved with the new system.

Staffordshire's powerful results come from a combination of policies. The command and control software programme VisiCAD has allowed extremely accurate predictions to be made about the likelihood of an emergency call emanating from a certain area at a particular time of day or day of the week. The process is known as system status management. Ambulances can thus be placed to meet demand, and community paramedic officers operating in cars are positioned strategically around Staffordshire, sometimes using new ambulance posts.

Some of the more rural areas of the county could never hope to have ambulances or community paramedic officers based close enough to reach emergencies in eight minutes, so Staffordshire ambulance service developed community first responder groups. There are now 17 such groups of volunteers in the county. I am very proud of the Mayfield and Ellastone first responders, who serve the residents in the northern area of my constituency, and the Abbots Bromley first responder group, which covers the area of my constituency that borders that village.

Recently, I had the pleasure of presenting a petition from the people of Mayfield and Ellastone in support of their first responder group. It called on the Government to guarantee the high standards of medical care enjoyed at present and to ensure that the community first responders would be allowed to continue to attend all the types of incidents that they attend now, without any reduction in the drugs that they are empowered to administer or in the equipment that they are allowed to use to help patients or to protect themselves. The petitioners also asked the Government to exclude Staffordshire ambulance service from the proposed reconfiguration programme until such time as its high standards were matched across the remainder of the proposed west central region.

Staffordshire is not unique in having volunteer community first responders, but ours are far better trained and empowered than those in other parts of the country. In Staffordshire, community first responders are not first aiders with a defibrillator; they are trained for nine months to the level of accident and emergency ambulance technicians. Mayfield and Ellastone first responders have two fast-response vehicles, one of
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which was recently purchased at a cost of £31,000. Half that sum was raised from the local community, the rest from grants.

The first responder groups in Staffordshire, all volunteers, provide cover 24 hours a day, seven days a week, 365 days a year. They are allowed to attend any emergency to which an ambulance would go, and use blue lights and sirens, as do full-time crews. They are allowed to administer oxygen and drugs such as glyceryl trinitrate, aspirin, adrenalin and glucagons. Indeed, I understand that the volunteers in Staffordshire are able to use more drugs than some ambulance technicians in other ambulance trusts.

The Mayfield and Ellastone first responder group has attended more than 700 cases in three years. Those first responders are understandably proud of what they do and do not want to lose any part of their role. They want to continue to treat people of all ages, including children, in all emergencies. I am aware that other ambulance services have adopted different aspects of the systems and practices used by Staffordshire ambulance service, and no doubt Staffordshire will be able to learn    some things from other services. However, Staffordshire's results are so outstanding that I believe that its service should be used as an exemplar for others.

A combination of innovative measures such as the use of system status management, community paramedics and community first responders and clot-busting drugs has produced such outstanding results. The people of Staffordshire believe that lives will be lost if the county's ambulance service is forced to join a west midlands service. They understand that a rate per 1    million of the population of 231 returned to spontaneous circulation from cardiac arrest and maintained to hospital compares exceptionally well with the NHS average of 52.

Given such results, the Minister will understand why there is so much concern in Staffordshire and why people there will not accept any change that worsens their service. Having taken on responsibility for out-of-hours care, Staffordshire ambulance service is also leading the way in bringing health care to the patient. Staffordshire is successfully treating nearly 50 per cent. of all emergency patients in their own homes, significantly reducing pressure on the local accident and emergency and other hospital services.

I know that the Minister wishes to raise standards in the ambulance service—indeed, throughout the health service—to the best possible level. However, that cannot be achieved at this time through the amalgamation of Staffordshire with the other services in the west midlands.

Take the protocols that the ambulance service adopts for community first responders. At the public consultation meeting held in Burton upon Trent, no guarantee could be given by the representative of the strategic health authority that Staffordshire's protocols would be adopted by any new west midlands-wide service. There would be a tendency to dumb down, so that other ambulance services could meet the requirements of the protocols. Similarly, the use of system status management could not be introduced
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overnight in areas outside Staffordshire, so the two systems—the traditional one and Staffordshire's system status management—would not mix.

I urge the Minister to consider a way forward that will protect our service in Staffordshire while offering more collaboration between Staffordshire and the rest of the west midlands service. There could, for example, be some shared back-office services. However, I firmly believe that Staffordshire ambulance service should remain operationally independent until such time as it can be guaranteed that the protocols and management system used in Staffordshire will be maintained in a merged regional service. In order to remain independent it will be essential for there to be separate boards.

If Staffordshire ambulance service is allowed to remain outside the merged service in the west midlands at this time, there could be a period of working towards a fully merged service. Staffordshire could join in with the new ambulance radio technology, while, of course, retaining the Staffordshire control room. That is essential to maintain the use of medical advice, which is an integral part of the management system.

Staffordshire would, of course, retain its current operation management system and the community first responders would operate with their current protocols. There could be collaboration between Staffordshire and a west central ambulance service in the development of SSM throughout the region, as well as in clinical audit and the evaluation of patients' experiences.

I hope that Ministers will accept the pleas from Staffordshire and allow its ambulance service to remain independent at this time. It would be possible to set a date for a future review—for example, 2010—or to accept that it should be left to both boards to come forward if they felt that amalgamation were right.

It has been said that the result of the consultation is a foregone conclusion. I was saddened by the decision of Roger Thayne and his deputy, Dr. Anton van Dellen, to resign from the Staffordshire service and to take up positions in Wales. However, I believe that the Staffordshire system that they have developed is strong enough to continue with new senior management.

I know that the Minister will not be able to announce any decision today, but I hope that she will be able to take away my suggestions and those of my colleagues about a way forward that will show that the voices of Staffordshire residents have been heard by Government.

Several hon. Members rose—

Mr. Joe Benton (in the Chair): Order. Before I call the next hon. Member, may I remind everyone that the debate lasts for an hour and a half? On such an important subject, I hope to be able to call everyone who wishes to speak. Therefore, I ask hon. Members to try to keep their remarks as brief as possible.

9.42 am

Michael Fabricant (Lichfield) (Con): One of the charming things about Staffordshire is that its Members of Parliament, regardless of party, often agree on what they think is best for their constituents. All 12 of its Members of Parliament, of which nine are Labour and three are Conservative, are unanimous in their
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agreement that the Staffordshire ambulance service provides a uniquely powerful service that saves lives in England and in our county. As the hon. Member for Burton (Mrs. Dean) said, we strongly believe that if it is merged with the west midlands service, the service in Staffordshire will be diminished; it will be done down to a lower common denominator.

I congratulate the hon. Lady on securing the debate. As she says, it follows up a long series of debates and meetings on this subject with Ministers and the Prime Minister. We feel strongly that there will undoubtedly be blood on the Government's hands if the Staffordshire ambulance service is not allowed to continue as it is.

The hon. Lady pointed out a statistic on resuscitations. On a rate per million of population, 231 recover from heart dysfunction in Staffordshire compared with a national average of 52. What she did not say was that in the west midlands, with which the merger is being proposed, the corresponding result is even less than 52; it is only 48. By some quick arithmetic, that represents a factor of roughly one fifth. In other words, if someone has a heart attack in the west midlands, they have only one fifth of the chance of surviving of someone who has one in Staffordshire.

I will not rehearse arguments that I have presented in other debates. Friends of mine, who both they and I thought were extremely fit, have had sudden heart attacks and have been rescued by the Staffordshire ambulance service coming to their door. It has a response time of just four or five minutes. The service has paramedics, defibrillators and other equipment, and decoagulant clot-busting drugs, which are used to save lives. Those friends of mine are alive today, and I have no doubt that if such situations had occurred in the west midlands that would not have been the case.

The response times in Staffordshire are tremendous. The Government rightly specify that for a 999 call in a life-threatening situation the ambulance should arrive within a response time of eight minutes. Staffordshire ambulance service achieves that 88 per cent. of the time. In the west midlands the figure is only 75 per cent. of the time, and its service is not always equipped with defibrillators, paramedics and the drugs that are needed to save lives. In the less serious type of emergency call, the response rate within eight minutes in Staffordshire is 85 per cent., compared with just 46 per cent. in the west midlands.

We all believe that if the Staffordshire ambulance service could merge into a larger regional service and maintain its standard while bringing everyone else up to that standard, that would be a good thing. The problem is that none of the professionals believe that is possible, which was one of the main reasons why Roger Thayne, the chief executive of the Staffordshire ambulance service, resigned. He just felt that standards would be lowered in Staffordshire. I have not met a single professional in the national health service who believes that Staffordshire would not be affected by the changes.

Given the United Kingdom's first-past-the-post system, which I support, our duty is to our constituents. My duty is to the constituents of Lichfield. The duty of all of us who are present today is to the constituents of Staffordshire. I cannot think of a more important thing than ensuring that when they fall ill, they are rescued
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and treated, and that lives are saved in the best possible manner. We can rejoice in the fact that the Staffordshire ambulance service enjoys the best response times not just in the United Kingdom, but in the whole of Europe. To damage that state of affairs would be appalling and there would be blood on the Government's hands.

I admire the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman). I remember that in 1994 or 1995, when things were going wrong for the John Major Administration, he said to me, "Michael, when things aren't going wrong don't do anything. Don't legislate. Don't make changes. When things ain't broke, don't try to fix them." Well, he did not put it in quite that way, because he is far too well spoken. I say to the Minister that the Staffordshire ambulance service, far from being broken, is a beacon to other ambulance services. To do anything to endanger that situation would be very wrong.

9.48 am

Charlotte Atkins (Staffordshire, Moorlands) (Lab): I congratulate my hon. Friend the Member for Burton (Mrs. Dean) on securing this important debate, because although the formal consultation has ended, the fight very much continues.

We all regret the resignation of chief executive Roger Thayne, but we must protect his legacy. Staffordshire still has his uniquely successful operating system and we must ensure that it continues to work in Staffordshire while he rolls it out to Wales. The Staffordshire ambulance service is Roger's vision, but it does not depend on just one man. The operating system that he has developed—system status management—can deliver without him, but only if it is headed up by someone who shares his vision and commitment.

During our previous debate on this issue, on 2 November, I focused on the remarkable performance of the Staffordshire ambulance service: some 88 per cent. of all emergency calls are met within eight minutes compared with a national average of 62 per cent. The rate of successful resuscitations from cardiac arrest has already been mentioned. Innovation and improvement are part of the Staffordshire ambulance service's day-to-day life.

In this debate I want to focus on another unique feature of the Staffordshire ambulance service: our community first responders. I know that other ambulance services have them, but none of them has them all trained to ambulance technician standard. They are called to every type of life-threatening emergency, including paediatric and maternity cases, and road traffic accidents. They are all volunteers, but they are not just gifted amateurs—they are professionally trained to take control of a broad range of medical emergencies. They work closely with the Staffordshire ambulance service and are familiar with all its procedures and equipment. Their vehicles are donated by local businesses or are paid for by community fundraising, and they are fully kitted out—they have all the emergency equipment that they need.

Community first responders are not an add-on. There are 355 of them—450 if we include all who are now trained. There are more of them than there are front-line Staffordshire ambulance personnel. They are an essential part of the Staffordshire ambulance service
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emergency response, and because they are local, they get to where they need to go in five minutes—not eight minutes. That is remarkable. No wonder Staffordshire ambulance service excels in saving lives by resuscitating people in cardiac arrest. The responders get there in five minutes because they can use sirens and flashing blue lights.

However, this could all be stripped away from 1 July. Why? Because in some areas community first responders generally operate on the first-person-on-the-scene protocol, where the most advanced level that they work to only allows them to administer oxygen and Entonox therapies. No other drugs are given, not even aspirin; there are no patients under 12; and there are no calls to road traffic accidents and only limited calls to trauma incidents. That might be acceptable to those who live in a town. However, Staffordshire, Moorlands has remote communities, including Flash, the highest village in Britain. It is rugged farming, walking and climbing country, with unpredictable weather and hordes of visitors, particularly in the warmer months.

Community first responders have consistently sought an assurance that they will be able to operate at their current level if a merger takes place, but no assurance has been given, so they fear the worst. If their protocols are watered down they will find that they are unable to give the treatment that they are trained to administer; for example, to a patient with a life-threatening asthma attack or a severe chest pain. As a result, their usefulness to the Staffordshire ambulance service would be reduced, leading to fewer call-outs, less hands-on practice and a severe loss of motivation. They would be less able to serve their communities, and it is inevitable that many volunteers would give up out of frustration. The result would be the end of a vibrant volunteer scheme that has the full support of local communities and has made a genuine difference to people in Staffordshire.

Testament to that is provided by the petition of nearly 4,000 signatures—collected in only a few hours—that I delivered to the Prime Minister last Monday. It is entitled "Save Staffordshire ambulance service community first responders", and it reads as follows:

I shall refer to two case studies from my bulging postbag to highlight the sort of work that they do. Mrs. Sheldon from Biddulph Moor writes:

Consultant cardiologist, Dr. John Davies, said:

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It was administered by first responder, Andy Sparkes. Mrs. Sheldon said:

the Staffordshire ambulance service exactly "as it is."

Another case involved Mr. and Mrs. Bowyer of Leek, who found their daughter had died of sudden adult death syndrome. Mrs. Bowyer writes:

Therefore, they do not just save lives; they also deal with the situations they find. This proves that the community first responders make a real difference.

As Labour politicians, we talk a lot about empowering the individual citizen to take control of their lives. We rightly praise the role of the voluntary sector, and all it does. The Staffordshire ambulance community first responders deliver on both those fronts. They are volunteers—very committed volunteers, whose commitment to their community leads them to undergo extensive long-term professional training, and to dedicate many hours to their service and to saving lives.

Community first responders are not just an add-on; they are integral to the Staffordshire ambulance service, which is a service that presses all the buttons that we would want a public service organisation to press. It has a uniquely successful management system, it is efficient and cost-effective, and its performance is exemplary, not only in terms of response times, but also in terms of saving more lives before people get to hospital.

It also already delivers on a new initiative recently announced by the Secretary of State to reduce emergency admissions and to save the NHS money. Staffordshire ambulance service treats 40 per cent. of emergency and urgent responses at home, saving £100 per hospital visit. That amounts to £9 million per year in Staffordshire. It also avoids unnecessary and stressful ambulance journeys to hospital, and prevents the hospital from being clogged up with patients who are better off at home.

When the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Hodge Hill (Mr. Byrne), responded to my Adjournment debate on 2 November, he described

and the

Nothing less than full operational independence will do. It is vital that Staffordshire ambulance service maintains its system status management operating system, and its high level of clinical protocols and procedures, including those for the community first responders. We want no dumbing down, no compromise on response times and no ending of innovation and development of staff skills.
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Staffordshire ambulance service should be used as an academy of excellence for other ambulance services to work alongside and follow. Let other areas benefit from Staffordshire's trailblazing. What matters is what works, not rigid regional structures, which will kill off Staffordshire ambulance service and cost lives.

Several hon. Members rose—

Mr. Joe Benton (in the Chair): Before I call the next speaker, let me say again that I propose to start the wind-ups at 10.30.

9.58 am

Dr. Tony Wright (Cannock Chase) (Lab): The hon. Member for Lichfield (Michael Fabricant) began his remarks by saying accurately that all Staffordshire Members had been working together closely on this issue. However, a few weeks ago the Conservative party had an Opposition day debate in the Commons that was a general attack on all mergers in the health service. As is the way on such occasions, the Conservative party voted for its motion, and the Government voted for their amendment. That is fine; that is how we do things. The problem is that the Conservative party propaganda machine then converted that into the statement that the Labour MPs for Staffordshire had voted for the merger of the Staffordshire ambulance service. That was an outrageous slur and I ask that the hon. Gentleman and the hon. Member for Eddisbury (Mr. O'Brien) to repudiate that in this debate, because it not only undermines all that we have done over the years in Staffordshire to work together on a cross-party basis, but damages our common endeavour to fight for Staffordshire ambulance service. These are important matters—far too important to play political games with.

If we found a public service that was cheaper to run and delivered outstandingly better outcomes than any comparable public service, what would we do with it? Would we cherish and nurture it, and use it as a beacon for others—an exemplar for the rest of the public services—or abolish it? I cannot overstate the extent to which the people of Staffordshire understand what an outstanding public service they have in their ambulance service. It is not often that people rally to their public services in the way that they have rallied to the defence of the Staffordshire ambulance service. They have done so not because they have been asked to, and not for any political reason, but simply because, from their direct experience and that of their families, they know that the service is outstandingly successful.

Those of us who go back a few years can remember exactly how the ambulance service became so successful. I remember witnessing its transformation at first hand. It was proposed that, instead of ambulance staff sitting around in ambulance stations waiting for accidents to happen somewhere out there, the service should be redesigned from top to bottom; that was thought outrageous at the time. The service decided to get the ambulance men and the ambulances out of the ambulance stations, to plot where accidents were most likely to happen, and to station ambulances there. That does not seem a staggeringly original idea now but, my goodness, 10 years ago it was. The effects were dramatic. At the time, the changes were quite naturally greeted with extreme apprehension by those who worked in or
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used the service. Ten years on, those who work in the service are intensely proud of what they have achieved. The buzz and the pride in that service has to be experienced to be believed. The feeling on the ground, from the people who use it, is unlike the feeling for any other public service that I know about.

In Staffordshire's case, it simply makes no sense to alter a service that is working so well. In some areas, it may well be sensible to merge ambulance services; somewhere down the track, when other ambulance services have reached Staffordshire's standard, it might even be sensible to consider making further efficiency savings by amalgamation. However, that is not the position now. The people of Staffordshire and the county's MPs would find it incomprehensible if the merger were to go ahead at this time. In terms of the Government's philosophy of public service reform, there is no reason at all for proceeding with the merger.

10.3 am

Joan Walley (Stoke-on-Trent, North) (Lab): I congratulate my hon. Friend the Member for Burton (Mrs. Dean) on securing the debate. I also congratulate Staffordshire MPs on the way the issue has been brought to the attention of the Government in meetings with Ministers, and on how, through Parliament, we have asked the Government to listen to our view about how their reforms are taken forward. I am glad to see our regional Minister for the NHS, the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton).

This is a critical and timely debate. What we want from it is reassurance from the Government that we have been listened to and that all the important changes that have come about in Staffordshire can play a pivotal role in the measures that the Government are taking, right across the NHS. Those changes are needed if the Government are really to bring about improved health services at community level, and that is something to which all Labour Members certainly subscribe.

Staffordshire's performance—its response times, its operational standards, how the service serves people, and how it goes about doing its business—is a matter of record. I am just looking around, and I see that I am the longest serving Staffordshire MP here today—

Michael Fabricant : And the youngest looking.

Joan Walley : And the youngest looking.

It is important that we take stock of the changes that have been made to Staffordshire ambulance service. Let me set out one of my concerns. Roger Thayne came to Staffordshire ambulance service and, as my hon. Friend the Member for Cannock Chase (Dr. Wright) said, set about changing things. Many of us, including my hon. Friend the Member for Staffordshire, Moorlands (Charlotte Atkins), have referred to the fact that those changes were opposed in some quarters because change is uncomfortable and is not easy. Staffordshire ambulance service, under the leadership of Roger Thayne, met that change head-on. The service worked with people; it explained, it informed and it then developed its different standards. The service is now far more able to cope with health problems in Staffordshire.
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Rather than looking to merge Staffordshire into a bigger ambulance service, the Government should consider how what we have can help them in bringing about change across the board, not just in ambulance services, but in health services more widely. Over the past 18 years or so, I have had meetings with Roger Thayne, Secretaries of State for Health and senior Ministers, and it has been incomprehensible to me why we have not seized the opportunity of using Roger Thayne's expertise—much of which goes into strategic planning—to drive forward the agenda for change. I ask the Minister to please look at how we can roll that out.

I am conscious that I have very little time, but I have one other point to make. Members who have spoken so far are really concerned about rural areas or towns in Staffordshire. I represent Stoke-on-Trent, the part of Staffordshire where health inequalities are greatest, and where disease and illnesses are worst. In Staffordshire, a model has developed to meet the needs of not only the rural, isolated areas, but the urban areas with the biggest health problems. Those urban areas face a great challenge in making change, because of our particular situation as regards overspend across our hospital trusts and at our university hospital. I say to the Minister, quite sincerely, that if we merge Staffordshire ambulance service into a west midlands service, we will end up with a far worse service. We would be completely dumbed down. We should be looking at how our ambulance service, with its operational independence, can help and can be part of a partnership dealing with the change that we need. In my constituency, we really have to meet more health care needs in the home, and we have to consider how we will deal with change.

I am mindful of the time, but just want to add that consultation has to mean what it says—it has to involve listening, not least to the views of Members of Parliament, who represent so many people across our county and cities, as my hon. Friend the Member for Staffordshire, Moorlands said. I am looking at the timetables for the Government review of the consultation. I do not know how many days or weeks it will be before we get a firm outcome, but today I ask the Minister to consider how what has been achieved under Roger Thayne's leadership can be rolled out across the west midlands, and to please listen, especially to the people of Staffordshire.

10.8 am

Mr. Robert Flello (Stoke-on-Trent, South) (Lab): I will keep my comments brief, as I am sure you will be delighted to hear, Mr. Benton. I, too, begin by thanking my hon. Friend the Member for Burton (Mrs. Dean). Many excellent speeches have been made, and I do not want to rehearse points that have already been put so eloquently, but I want to raise a couple of points that have not been addressed.

The first point is about the excellent work that Staffordshire ambulance service does in respect of the M6 motorway, which runs through the county. As many hon. Members will know, surprisingly enough, from time to time there are traffic jams on the M6, even
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though there is a relief road. Often, people are caught up in their vehicles and become unwell—perhaps they are diabetic, or perhaps the stress of the long, tiring journey brings on other ailments and illnesses. Staffordshire ambulance service operates an excellent service in those circumstances, rescuing drivers and passengers from vehicles, bringing insulin to them, and so on. I understand that that has not been taken into account when considering the service standards of different ambulance services, so I would like to make sure that that is on the record.

The other point that has not been mentioned so far is the star ratings of the ambulance services. Staffordshire ambulance service has the highest three-star rating—if four or five-star ratings were available, Staffordshire would be at the top of those. That can be compared with the west midlands service, which I understand has a one-star rating. It is worth stressing that that is not a reflection of the quality of the people in the west midlands service. I am certain that they do the best job they can in the wider west midlands region, but they do not have certain drugs or the systems, equipment or protocols in place to use them. The ratings reflect the systems and what is available, not the quality of the people, although I must say that in Staffordshire we have some fantastic ambulance crews and first responders.

Why would the people of Staffordshire want to have anything less than the excellent service that they have now? Why would somebody who had grown used to being able to phone the emergency services and request an ambulance, knowing that in the vast majority of cases one will come in less than eight minutes, want to change that for a system that was not so reliable, could not prescribe the drugs and was not so close to where an incident had taken place?

I echo the comments made by my hon. Friend the Member for Stoke-on-Trent, North (Joan Walley). I, too, represent a part of a Stoke-on-Trent, an area that has long been overlooked. Historically, health has been a great challenge there, with issues arising from people working in the mines and the steel works, and in the pottery industry, which thankfully we still have. People in the area have come to expect a high standard and have a great need for high-quality health care. That is reflected well in the fact that although there are different views on police mergers and primary care trusts mergers, there are not different views on the ambulance service merger. The people of Stoke-on-Trent and of wider Staffordshire speak with one voice on the issue: the ambulance service is the best service and we do not want to lose it. That sentiment is illustrated well by a small group that meets at Longton town hall for a tea dance on a Monday afternoon that, between its members, managed to come up with a petition of 400 signatures. That is the strength of feeling from one small group.

It is quite right that we should want to improve the ambulance service throughout the country, but the proposal that my hon. Friends have put forward in this debate is a better way forward. Let us make Staffordshire a shining light to guide others towards excellence in the ambulance service.
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10.13 am

Mr. Brian Jenkins (Tamworth) (Lab): I shall be brief. I shall not repeat what my hon. Friends have said, but I must repeat one thing: congratulations to my hon. Friend the Member for Burton (Mrs. Dean) on securing this debate at an important time, with the consultation completed and the evaluation taking place.

I am against the Staffordshire ambulance merger. I want to make that perfectly clear because, as my hon. Friend the Member for Cannock Chase (Dr. Wright) indicated, when I went to speak to my Conservative-run local authority and explain my position—quite clearly, I thought—the Conservative party's spin machine in my part of the world accused me of lying and of doing one thing in Tamworth and a different thing in London, because I voted against the Opposition day motion. I do not want to pursue that point because it is now in the hands of the lawyers. The man involved is not working, unfortunately, so I shall not get much money off him. He is on his own account rather than his party's account—I am sure that I could have got a sufficient amount off the party.

The annals of this country's history show that the royal family used to have a whipping boy for the prince. The whipping boy used to play with the prince and if the prince misbehaved, the whipping boy got whipped. The belief was that the prince would not misbehave because he liked the whipping boy. One of the things that modestly surprises me is how gentle my hon. Friends from Staffordshire have been with the Minister. Although I have nothing but respect for her, I get totally incensed when somebody is sent along with a speech that has been prepared before the debate has even taken place.

I have no need to run round with a petition—believe me, I know exactly the sentiments of the people who live in my town and my constituency, because I live there. All the Staffordshire MPs and all my constituents are incensed. I was particularly incensed when I saw the new post of chief executive officer of the new, enlarged west midlands service not only being advertised but being filled even before the consultation had finished. I do not mind if that can be explained as plan B, but it stinks of a stitch-up and suggests that the consultation period was nothing but a sham. If my hon. Friend the Minister gets up and explains what she has done, and we come out even reasonably successfully, I will willingly apologise. However, I feel that she has a lot to say to convince me that we have not gone a long way down that route.

Every hon. Member will speak of the excellence of the Staffordshire ambulance service, but I when I try to find out why we are under threat I come back with my ears ringing with gobbledegook. I am told, "Technology—that's the answer. It's technology that's driving us," or, "It's a new strategic approach to the provision of service." Well, let me talk about technology. No one is opposed to a new radio system that covers not only the ambulance service, but the police, fire and all our other emergency services. When the technology is deliverable, we will grab it both hands, because then we can direct people faster to where they should be.

We can create a control room and if necessary, a back-up control room under the new area. The only control room that has gone down was the Greater Manchester one, which went down for 10 hours. And
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guess what? There was no back-up. Why was there no back-up? We are told that in the new, enlarged west midlands area we will have a control room and a back-up control room. Do we send the people down there, with their back-up machines and back-up staff who will be used perhaps once every six, seven or eight years when the main control room falls over? I think not. Do we rotate the staff, to have a week in the main control room and a week in the back-up control room? I think not.

If we want a control room mechanism, I can suggest one. We link up all the existing control rooms in the region, so that if one control room falls over, the work is immediately allocated to the remaining control rooms, where it is dealt with by people who are used to dealing with emergencies every day. If the reason that I have been given is the reason we are merging, it is a silly reason and should not have seen the light of day.

We are not opposed to planning. Anyone would be a fool to think that there was no need to plan on a regional basis for a disaster, large emergency or catastrophe, or to allocate resources for that. However, anyone looking at that would be a fool to think that ambulances or fire engines could immediately be brought from 30 or 40 miles away. Of course we cannot do that—the first ones on the scene are the local ambulances and fire engines. After that the ripple effect starts and we call in services from two, four and then six miles away to fill the vacuum created. We are not opposed to that. We would be stupid to be opposed to something like that, and the people of Staffordshire are not stupid by any means.

When I look at the plan, I see no realistic rationale. That is all that I ever asked for from the Government. I    am not opposed to change, modernisation or reorganisation, but I am opposed to reorganisation for the sake of it. I am opposed to reorganisation when it takes valuable resources from the scarce resources of any department, which then neglects its everyday duties. We see calamity and sickness in the delivery of public services when so much time is spent on reorganisation.

I want the criteria to be laid down clearly from the start. In many areas the Government have failed to give the financial information, the criteria and the rationale for the change. That is why I am not pleased, especially when it is my Government who are doing this to us. It would be a disaster and a tragedy if we relied on a Labour Government to take the service in Staffordshire back. I do not intend to see any of our public services taken back under this Government. I urge the Minister to consider the matter and to try to convince the officials who first came up with the plan and are pursuing it that they should change their minds and do an about-turn before they run into a brick wall.

Mr. Joe Benton (in the Chair): I intend to call the hon. Member for Stone (Mr. Cash), but I indicated during his absence that I propose to start the wind-ups at 10.30.

10.21 am

Mr. William Cash (Stone) (Con): I apologise, Mr. Benton, for being a little late. I was tied up with another engagement.

The merger has been uniformly condemned by the people of Staffordshire. Indeed, I have presented a petition to Parliament, as the Minister knows, and I have several thousand protest letters, which I shall present shortly to the Department of Health.
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The whole exercise is an example of a cash-driven, vicious attack on an extremely good ambulance service. We have today heard condemnation of the Government's position. I urge the Minister to take the matter back and to give it serious consideration because the merger has been rejected by the local people. There is enormous anger throughout the county and particularly in my constituency.

I pay personal tribute to Roger Thayne, who did a fantastic job. It is well known that we have the fastest 999 response rate in Europe. We have the best ambulance service. As with the mergers of the police and other services, the suggestion that the ambulance service should be merged is part of a regionalisation process that is driven by deep and radical insistence on change to save money. All I can say is that the whole process should be rejected out of hand.

I agree with the remarks that a proper analysis is needed, which the Government have not so far succeeded in producing. For the most part, it is perhaps a little disingenuous for some hon. Members who voted against the proposals—[Interruption.] I see that the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) is huffing and puffing, but this is a serious matter. It is not something that can be washed aside. There have been occasions when some of us have voted against our own Government when circumstances have required that, and it is important to make that point—

Joan Walley : On a point of order, Mr. Benton. May I ask for some direction about hon. Members who come to the debate without having had the courtesy of listening to the opening comments? The issue was raised quite adequately by my hon. Friend the Member for Cannock Chase (Dr. Wright), but the hon. Member for Stone (Mr. Cash) came blind to the debate.

The Chairman : I am sorry, but that is not a point of order. It is purely a matter for debate. I am quick to rule any hon. Member out of order if they contravene any of the rules of debate.

Mr. Cash : I am extremely grateful to you, Mr. Benton. I make the point, because it is a matter of fact.

Charlotte Atkins : Will the hon. Gentleman give way?

Mr. Cash : Not at the moment. I am extremely glad that some of the comments that have been made have indicated a degree of change of mind and that is encouraging. I was encouraged by, for example, what the hon. Members for Tamworth (Mr. Jenkins) and for Stoke-on-Trent, South (Mr. Flello) said.

Charlotte Atkins : Will the hon. Gentleman give way?

Mr. Cash : I will not give way to the hon. Lady.

This is a matter of profound importance to the people in my constituency who are affected by votes that take place on the Floor of the House, which is where such matters are decided. I challenge the Minister unequivocally to repudiate—

Charlotte Atkins : On a point of personal explanation, Mr. Benton. The hon. Gentleman accused me of huffing
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and puffing. I was merely indicating dissent because he suggested that I voted for the merger of Staffordshire ambulance service. I voted against a highly party political Opposition motion, which referred to mergers in general, not to Staffordshire ambulance service.

The Chairman : That is not a point of order, but I have allowed a point of explanation. I remind hon. Members that the winding-up speeches will start at 10.30. It has been an interesting debate and it is only right and proper that we ask the Minister and the Opposition spokesmen to reply at 10.30.

Mr. Cash : I am grateful to you again, Mr. Benton.

The problem in Staffordshire can be remedied and I look to the Minister to do so. I am extremely glad to note that there has been a change of heart on the matter.

Dr. Tony Wright : I ask the hon. Gentleman to withdraw the remarks that he made a moment ago because he does a huge disservice to the common cause that we are fighting. He knows full well that the Opposition debate and motion to which he referred made no reference whatever to the ambulance service in Staffordshire. To use that for party political purposes undermines all the common cause that we have made and are making again today. I ask him, on reflection, quickly to withdraw what he said.

Mr. Cash : I am not going to because the principles contained in that motion are applicable in this case. I am glad to note that there has been a change of heart. I am making that clear, but I am not going to deny the facts as I find them because this is a matter of profound importance to the people in my constituency who were affected by that vote in the House. Therefore, I will not retract my remarks. However, I am conscious of the fact that there have been specific examples, which I have given already, of a change of heart and that is extremely encouraging. I hope that the Minister will take that on board because the proposal is disgraceful and should be withdrawn. It is incumbent on us as Members of Parliament to spell out the facts, so that people can see what happened and take account of the feelings that have been expressed on both sides of the House.

10.28 am

Dr. John Pugh (Southport) (LD): I congratulate the hon. Member for Burton (Mrs. Dean) on introducing this important date and all Staffordshire Members who have been tigerish in defence of their cause. As an external observer, may I comment that one thing that can lessen the force of that cause and disfigure it is political division, when there should be unity in this place and on the ground in Staffordshire. From my experience of past health campaigns, I offer a friendly word of advice: that sort of behaviour leads to poor results for the people we serve.

The debate is timely. The Minister will make a statement and may pull the rug from under us, or a rabbit out of the hat, whatever the appropriate metaphor is. I shall start with a few general comments.

No one wants to have much to do with ambulance services on a personal basis, although there are occasions when we are all desperate to see one. Our
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fundamental requirement is that the service should be quick, efficient, effective, high-tech and well resourced. It should be human and sympathetic because it is in the front line and the public use it in situations of high stress.

Most of those remarks probably apply to the non-blue light service as well, but emergency patients are not normally much interested on such occasions in the name or structure of the trust that serves them, the badges on the ambulance, the origin of the ambulance or any of the minor administrative details. None the less, the administrative structure is not completely unrelated to delivery. I am sure that you are familiar with the situation in my constituency, Mr. Benton. There are two hospitals near each other, and the path between them is divided by two ambulance trusts. It is a woefully inefficient arrangement, and empty ambulances often cross one another on the same road. They could be using their resources far more effectively.

There is a question about the optimal size of an administrative unit—obviously, the more units and boundaries a trust has, the more issues it has to deal with in respect of boundaries—and there are questions about efficiency. There is not much of an issue in respect of the democratic accountability of ambulance trusts. There have been many debates about why a primary care trust or an acute trust is not properly democratically accountable, but there is not the same level of comment about ambulance trusts. Yet there is a genuine issue around making ambulance services efficient.

You will be aware, Mr. Benton, that the ambulance service that serves our area, the Mersey regional ambulance trust, has been accused of being less than efficient and has recently taken steps to be more effective. However, decisions on reorganisation must not be taken on the basis of temporary factors—who happens to be running the ambulance trust at the time and what the current performance data are. They should be responsive to what might be considered to be permanent changes.

For example, there has been a significant change in the skill level and competence of ambulance crews over the past few decades. They are far more competent and able than they were years ago. There is a prevalence of co-responding and looking across the piece at how emergency services integrate that did not exist before, and, with satellite navigation and so on, there is less concern about fixed bases and where ambulances are located.

That leads to certain presumptions. There is a rational and reasonable presumption, for example, in favour of co-terminosity of emergency services. There is a presumption in favour of economies of scale, as bigger units often possess better resources and have lower overheads, but it is not an absolute presumption. It needs to be tested empirically, not dogmatically, and that is what the contributions to this debate have helped to do.

There are other strong presumptions. One that I believe we all have, to some extent, is that locally based services are more locally sensitive. Another one, which has already been mentioned in the debate, is that we should not endeavour to fix something that is not broken, and it is clear that the Staffordshire ambulance service is not broken at all.
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It would be easy to get out of the dilemma by spouting the usual clichés—we should not go for one size fits all, we have to consider whether things are fit for purpose—and in a minute or two I could find myself using words such as "step change" and the kind of gobbledegook that tends to cloud these debates. What we have here, and what has been argued sensibly by hon. Members, is a good prima facie case against change.

Certain factors make it a good case. Extraordinary statements have been made by the chief executive and deputy chief executive of the Staffordshire ambulance service that would not have been made were there not genuine and serious concern. Extraordinary efforts have been made by all local MPs, and that is reflected by the number of them involved in this debate. There are stark statistical contrasts between Staffordshire and the surrounding areas with which it is intended to merge, and there have been some serious accusations that the approach is completely dogmatic, relatively unreasoned and resistant to evidence.

The Government must satisfy us by demonstrating that there has been real consultation, and that the decision is evidence-led and responsive. They must be totally up front about what they are prepared to leave to local democratic decision making—or even just local decision making. If decisions are not to be made locally, if some template is to be writ large across the country, they may as well say so now. If not, perhaps we could review the criteria that are being used for this exercise and get an independent evaluation of how fairly and objectively they are being applied.

In a nutshell, the trust is making a decent, reasonable and rational case to remain a beacon of good practice. It has not been said in this debate, but I presume that there would be no detriment to surrounding areas if it did so, and that, in essence, is the case that the Minister must answer.

10.35 am

Mr. Stephen O'Brien (Eddisbury) (Con): It is a pleasure to serve under your chairmanship, Mr. Benton.

I believe that everyone in the Chamber feels genuine gratitude to the hon. Member for Burton (Mrs. Dean) for having secured this debate, which is not only important but extraordinarily timely, following the discussions in the House.

We have heard from many hon. Members who represent Staffordshire. I would like to confirm the apologies of my hon. Friend the Member for South Staffordshire (Sir Patrick Cormack) who, but for a prior engagement that he simply could not avoid, would have been here. He supports the unanimous view expressed by Staffordshire MPs on both sides of the House.

In this age of consensual politics, I am sure that we would agree on what a perfect ambulance trust would look like. It would consistently achieve a three-star rating. Year after year, it would improve its response rates and achieve well above the eight, 14 and 19-minute targets, at both categories A and B, and the GP urgent call targets. It would be the best at resuscitation, it would balance its books—especially during this time of Government-precipitated crisis in the NHS—and it would be the most economic. In fact, within its budget, it would invest in innovative techniques and extra protocols above and beyond the statutory ones. It
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would employ more doctors than any other trust, its chief executive and staff would have the best interests of the trust at heart, rather than being focused on assuring their pensions. Such an ambulance trust would be looked up to by other services around the world. Indeed, its chief executive would, no doubt, travel to other countries to speak to ambulance services personnel.

Hon. Members may be surprised to learn that all those attributes of the perfect trust are, in fact, attributes of the Staffordshire ambulance service NHS trust, which serves all the people of Staffordshire. Who on earth, be it a Government or a Minister, would seek to change or scrap that if they were in their right mind?

I ask that with some feeling. Like the hon. Member for Southport (Dr. Pugh), I suffer from being in the area of the Mersey regional ambulance service, which has had a disastrous time. The ambulance service of Cheshire, a proud county, was perfectly adequate until it was rammed into Mersey against local will. What has happened? The service once had a number of stars, but it has collapsed to a nil rating. There is no surprise there, except to deaf Ministers, who were warned. They cannot pretend that it is somebody else's fault, or that it was an unintended consequence of a wider, benign idea that was dreamed up in the halls of new Labour. The change was intended, it happened, Ministers are accountable, and we all share in their shame.

Staffordshire is about to be precipitated into exactly the same crisis unless the lesson of the Mersey regional ambulance service is learned and at last the Government listen to the speeches, sincere and full of integrity, of hon. Members on both sides of the House. It is not easy for a Government Back Bencher or representative to have to find a distinction between the Government whom they have been elected to support and their decisions.

The West Midlands ambulance service, with which the Government are trying to merge the Staffordshire ambulance service, has dropped from three stars to one star since 2002. It only just makes its targets, and at month six it was running a deficit of £1.1 million—part of a deficit in our NHS that is so embarrassing for the Government that they continue to withhold up-to-date figures. The situation may be worse than I have just cited.

It is also widely agreed that a merger of Staffordshire ambulance service would cause a cut in patient care. The—sadly—former deputy chief executive, Dr. Anton van Dellen said:

The Staffordshire ambulance service operates 36 protocols above the national statutory ones. There is not even a great cost. Dr. van Dellen calculated that it was £11.2 million in the first year and £5.1 million in years three, four and five—all done within budget. Even the strategic health authority officials admitted at the Birmingham city council health overview and scrutiny committee on 11 January this year that

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That point was made strongly by the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) and others. It is a point I strongly relate to, having a rural constituency myself.

Many groups—health and oversight committees, the    women's institute, local councils and local campaigners—are united in their condemnation of any plan to merge Staffordshire ambulance service. As we can see from today's debate, Opposition and Labour Members have united in common cause. There has been a bit of an edge in one particular area. I would give a tiny word of advice to the much respected hon. Member for Cannock Chase (Dr. Wright)—and I share that respect—who has been particularly aggrieved by the normal fare of parliamentary activity during Opposition-day debates. If anything has been proved during recent weeks, it is that the Government pay heed only to the squeaky wheel. It appears that rebellions can count, and it would have been interesting to think about that as a political tactic on that occasion.

Mrs. Dean : Does the hon. Gentleman accept that Staffordshire is unusual in that MPs from both main political parties have worked together for the benefit of the people of Staffordshire? Does he think that the appalling comments from the hon. Member for Stone (Mr. Cash) undermine that situation?

Mr. O'Brien : It is highly presumptuous, in trying to make a uniting point, to divide. I do not think that that was very helpful, given that there has been respect on all sides for the way in which the debate has been conducted. My point relates to the edgy point raised about the Opposition-day debate. I seem to recall that that is precisely what happened when we were in government: the Opposition-day debates were used by the Labour party in exactly the same way. Indeed, as my predecessor in my constituency tells me, local campaign material was used to that precise effect.

Dr. Tony Wright : The hon. Gentleman has one simple remedy, which is to put the record straight. He should say that the Opposition motion made no reference at all to Staffordshire. There can be legitimate argument about whether mergers of different bits of the health service should take place in different parts of the country. The motion was not about Staffordshire, but it was used by his party to traduce Labour Members with the allegation that they voted for the merger of Staffordshire ambulance service, which simply was not true. I ask him to repudiate that, then we can get on with the rest of the debate.

Mr. O'Brien : I am not going to repudiate it on the basis that the way in which people interpret the way things are done in this House—the motion is on the record—is a matter for them to deal with in their local campaigns. There is genuine and principled opposition from the official Opposition to the crass approach taken by the Government to try to ram together, by means of a regionalisation dogma, organisations that run perfectly well, whether they are part of the NHS, the police, the fire service or local authority representation. Staffordshire ambulance service is probably the biggest victim because it so excellent and such a beacon. If one can only relate, for political cover, to the particular,
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instead of recognising that this is taking place under a general principle advocated officially by a Government with Executive power, that is naive. I put that on the record as a counter to what has been an unfortunate edge in this argument.

Furthermore, nothing is more transparently weak and disingenuous than saying as an excuse that we are waiting for a final decision to be made. That excuse was even made by the Prime Minister at Prime Minister's questions, when he said:

We are all keenly aware that the final decision was probably made some months ago in the minds of Ministers and Whitehall bureaucrats. Indeed, it was hinted at earlier. Why else would the NHS Appointments Commission have advertised for, and appointed, a pool of nine people to be heads for the new regional ambulance services? I have had a letter from Roger Moore, chief executive of the commission, stating that it

Why else would the Government be misrepresenting the findings of Peter Bradley? He recommended a reduction from 31 trusts to 28, which was coterminous at that time with the number of strategic health authorities. There was no suggestion of a change down to nine, 11, 12 or whatever it may be. Ministers have used that as an excuse to reduce the number of ambulance trusts to nine, 10 or 11, just as they have invented the idea of the reconfiguration of the SHAs after the Bradley report. That is sleight of hand, it is an abuse and there is no evidence base whatever—not in Bradley's report—to support the Government's reconfiguration of ambulance trusts to regional remote bodies, which will level down to the performance of the lowest common denominator. Anyone with a scrap of management understanding knows that benchmarking to raise all to the level of best practice requires people to be separately configured, rather than merged and diluted into one.

In conclusion, we know that Staffordshire ambulance service is one of the best in the world. That is largely due to the hard work of Roger Thayne, and his deputy Dr. Anton van Dellen, to whom we pay warm tribute. Mr. Thayne felt his integrity would be impugned if he did not step down, citing among his reasons the desire

and the premature

He has been effectively forced out by a process designed and managed by Ministers.

If the service is merged into a regional trust, the 36 extra protocols will be dropped. Staffordshire delivers those protocols within budget and they save lives. Trust and SHA officials have said that that will lead to a downgrading in patient care. The Secretary of State has presided over a sham national consultation, deliberately spinning Bradley's findings to support the Government's regionalisation agenda and appointing chief executives before the consultation has even finished. Unsurprisingly, that has destabilised a wonderful chief executive who has shown the way for everyone else.
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If the Minister presides over the end of the Staffordshire ambulance service, she will prove that the consultation is a sham, taking into account neither the excellence of the service nor the wish of the people. The best possible single-word speech the Minister could make to every single man, woman and child in Staffordshire, and every constituent of the Members here today, is to say yes to the question I shall put to her. For the Minister, after the so-called consultation, the game is up. If she is to have a shred of credibility, she knows that the only speech she can give is yes in answer to my question. Will she confirm that the Staffordshire ambulance NHS trust will remain as it is: unmerged, independent, excellent and delivering services that the rest of the country would be proud to match?

10.48 am

The Minister of State, Department of Health (Ms   Rosie Winterton) : It is a great pleasure to serve under your chairmanship, Mr. Benton.

I congratulate my hon. Friend the Member for Burton (Mrs. Dean) on securing the debate, which, as the hon. Member for Eddisbury (Mr. O'Brien) said, has by and large been constructive. He used the word integrity in describing many of the speeches that have been made. I agree with the hon. Member for Southport (Dr. Pugh), however, that the behaviour of the hon. Member for Stone (Mr. Cash), who came in late and made a speech that broke what has been quite a good consensus in the debate, was extremely unfortunate. I completely understand the fears and distress of Labour and, I suspect, Conservative Members that that approach has not helped the debate. It does a disservice not only to the hon. Gentleman's constituents but to those of my hon. Friend the Member for Burton. It is no wonder that they feel disturbed by that approach.

We are talking about an excellent ambulance service. I know that, because I visited Staffordshire ambulance service with my hon. Friend the Member for Burton. I was extremely impressed as we walked through the tents and into the hall and met so many of the members of staff, who were clearly incredibly committed to providing such an excellent service.

My hon. Friend the Member for Cannock Chase (Dr.   Wright) talked about changes that had been controversial. In my own constituency, after some of the changes were put in place, ambulances were not necessarily in the ambulance station, but in different parts of the area. As he said, those changes have been accepted. Staffordshire has led the way with a three-star rating, as my hon. Friend the Member for Stoke-on-Trent, South (Mr. Flello) noted. It is a tribute to the work that has been done.

My hon. Friend the Member for Stoke-on-Trent, North (Joan Walley) said that we must consider how we can transfer best practice to different areas. That is what we have been doing. I visited Staffordshire when I had ministerial responsibility for ambulances, and I feel strongly that there has been almost a revolution in the way in which ambulance services are delivered. We considered them closely, because they had an impact on waiting times in accident and emergency departments. The ambulance services are much more integrated with the general emergency services, and so much a part of the way in which we ensure the transfer of best practice to other areas. I agree with my hon. Friend that we must do that.
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NHS ambulance services handle about 6 million 999 calls each year, and spending on ambulance services has increased by about 75 per cent. Response times and patient care have improved significantly, and some revolutionary changes have been made. We need to build on those achievements. We needed to consider how we could review ambulance services to ensure that improvements in service delivery were consistent throughout the country. That is why we published a service review last year.

The implementation of that review will be one of the biggest transformations of the service for more than a decade, and I think that it will deliver good services to patients in terms of the range and quality of care that they receive. To support those improvements, the way in which ambulance trusts are structured and managed needs to change. We must consider the capacity to plan for tomorrow, as well as to deal with today. They could do that if some of the perceived artificial barriers were removed. We must consider how to improve regional resilience, integrate planning and service delivery and ensure that there is co-terminosity with other service providers.

In that context, I turn to the point of order raised by the hon. Member for Lichfield (Michael Fabricant) about the written ministerial statement. The Secretary of State for Health published it at half-past 9 this morning. Essentially, it confirms that the strategic health authorities will submit reports on the consultations on ambulance trust reconfiguration proposals by 5 April. Decisions will be announced as soon as possible after that, with the intention that new ambulance NHS trusts will be established from 1 July. I have copies of the written statement. I did not want to hand them round earlier, but with your permission, Mr. Benton, I should be perfectly happy to do so.

Mr. Joe Benton (in the Chair): It might be appropriate if the hon. Lady were to place the statements on the Table.

Ms Winterton : I shall certainly do that.

Mr. O'Brien : Although we shall obviously read the detail of the statement, in light of what the Minister has just said and given the NHS Appointments Commission appointments to which I referred, all that is required
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from her now is to find out whether from 1 July—a date that comes as no surprise, because it had been canvassed before—there is any prospect of Staffordshire retaining its independent, stand-alone status, or are we all shadow boxing?

Ms Winterton : I shall come to some of the points that the hon. Gentleman has made, but a pool of people has been appointed because we want to ensure that, when any changes are made and if any new trusts are set up, they can get moving as quickly as possible. It has been perfectly clear in all the adverts that change depends on the outcome of consultation.

All hon. Members have paid tribute to the work of Roger Thayne and his deputy, and reference has been made to their resignations. I assure hon. Members that Shropshire and Staffordshire strategic health authority is working with the ambulance trust to secure robust management.

My hon. Friends the Members for Burton and for Staffordshire, Moorlands (Charlotte Atkins) praised the work of local community responders. They are important people, and the recent ambulance review envisages such schemes being a key part of the increased flexibility and type of responders whom ambulance services dispatch. I assure my hon. Friends that we expect the community responders scheme to continue if the proposed merger goes ahead.

I shall finish by addressing some clinical practice issues. I assure my hon. Friends that the strategic health authority has already, as part of normal contingency planning for any proposed merger, set up a group to consider the procedures and protocols throughout all trusts in the west midlands. I am confident that it will help to ensure that future practice will be the best for all patients, including those in Staffordshire.

My hon. Friends have made some constructive suggestions about the way forward, and I am grateful to them for having put forward those ideas. I shall take them forward and ensure that my noble Friend Lord Warner receives details of them. I am sure he will consider those issues with interest, as we are keen to ensure that all views about the proposed merger of ambulance services in the west midlands and, indeed, nationally are given proper consideration before any decisions are made.

I thank hon. Members who have been present for the whole debate for their contributions. As I said, I shall pass on their views to Lord Warner.
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