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5 Dec 2006 : Column 34WH—continued
“However, in addition to the specific legal restrictions, Trusts need to ensure that their clinical governance arrangements are sufficiently robust to ensure safe and effective practice. This would need to cover issues such as the training of community first responders, guidance on the use of medicines, storage and stock control”.
Michael Fabricant: The hon. Lady is correct to read that out and I am grateful to her for doing so, but she will know that the previous chief executive sought advice on those very issues. He was assured that the standards of logistics, training, storage of drugs and so on met those requirements, which, moreover, are tighter than those that are in place in Northumbria and the east midlands, where the drugs are still being used. Why has it suddenly been decided that the protocol is illegal, when previously the protocol, which had been considered by the Department of Health, was judged to be legal?
Charlotte Atkins: I am coming to that issue. What the last paragraph of the MHRA’s statement indicates is that the Staffordshire ambulance service needs to ensure that the training of community first responders and the guidance on the use of medicines, storage and stock control are up to full scrutiny.
The training of community first responders in Staffordshire is certainly more extensive than in any other training regime for community first responders, with a minimum of 160 hours, proper assessment, five shifts with ambulance staff, and hands-on experience of up to 16 hours. The training regime is similar to that for ambulance technicians, but the problem seems to be that it is not approved or accredited by an outside medical body. I understand that it is provided by Northern college, which does not even award any qualification.
That seems an awful waste, because many people spend more than eight months, and sometimes nearly a year, training to become community first responders. They put in all that time and effort, entirely voluntarily, yet at the end of the training they do not receive any recognised qualification. They are regarded by the trust as lay people, when they clearly have a lot of expertise and are, in effect, ambulance technicians. The acting chief executive, Geoff Catling, is going to look at the training syllabus, but I do not understand why that has not been done before. Although there might be an issue concerning the amount of hours that community first responders can spend with a qualified paramedic or technician, the training is virtually identical to that of an ambulance technician.
It is nearly six weeks since the drugs were withdrawn, and I am concerned that there is evidence that some community first responders are voting with their feet. Some are not responding to certain calls. The problems centre on the withdrawal of Salbutamol, GTN and
Entonox, because the community first responders now cannot offer relief for an asthma attack, treat chest pains or offer pain relief for trauma. They cannot use those drugs and therefore have to sit back while they wait for the ambulance. They can use treatments such as adrenaline in certain circumstances, but often they have to sit back unnecessarily while the patient is suffering, even though they know full well how to relieve that pain.
The Staffordshire ambulance working group is meeting tonight to try to find a way around that problem, but for us all, particularly the community first responders, things are taking far too long. The withdrawal of the drugs is clearly a temporary measure, but many community first responders are becoming disillusioned. Perhaps it is not surprising that conspiracy theories abound, many of which we heard from the hon. Member for Lichfield. According to those theories, the decision is supposedly about dumbing down the Staffordshire ambulance service and reducing its effectiveness, so that a merger with the West Midlands ambulance service can come about. That is because a merger will not take place until the performance of the West Midlands ambulance service matches that of the Staffordshire ambulance service. However, all the talk of dumbing down does great discredit to the hard work that is done in the ambulance trust every day of the year.
The same sort of claims have been made about the withdrawal of the ResQPOD. However, that decision was prompted by none other than Dr. Anton van Dellen, the former deputy chief executive and Roger Thayne’s right-hand man. Anton was concerned about the theoretical risk of fluid accumulating on the lungs when the ResQPOD was used with the LUCAS device, normally known as the “thumper”, during the treatment of cardiac arrest. The opinions of three external experts have now been sought, and their recommendations are now with the director of clinical performance, Dr. Matthew Wise, for his consideration.
Michael Fabricant: I am familiar with the ResQPOD device. It is interesting. On the issue of blood arising in the pleura, one has to remember that the patients are dead. The experiment was done two and a half years ago and there is some doubt about it. As I said, if there were any doubt about whether the ResQPOD is safe, would it be as widely used as it continues to be in other ambulance services in the United Kingdom, the United States, Canada, France, Germany and Scandinavia? That experiment is irrelevant. Once again, only in Staffordshire do we suddenly discover that such things are an issue.
Charlotte Atkins: I bow to the hon. Gentleman’s greater medical knowledge, but Anton van Dellen is and has always been well respected in the trust. I do not believe that he would decide—and it was his decision to make—to withdraw the ResQPOD unless he was worried about it. He originates from South Africa and has huge experience. He is well respected by paramedics, management and community first responders. The decision had to be his.
In conclusion, I should say that there is real concern in the Staffordshire ambulance service about the withdrawal of the drugs and the ResQPOD. A very long time has passed, certainly since the ResQPOD was withdrawn from service. I urge the Minister to involve his officials to try to speed up the process.
We are coming up to the Christmas period, when community first responders will clearly be in great demand. I urge the Minister to try to ensure that there is a decision before Christmas on both the drugs and the ResQPOD, so that the performance of Staffordshire ambulance service can continue to be as great as always. As yet, there has been no evidence that those withdrawals have led to lower performance on the part of the ambulance trust.
I have no problem with the partnership between Staffordshire and West Midlands ambulance services. That has nothing to do with the withdrawal of the ResQPOD or the drugs. However, it is important that we overcome the problem, because the future of our community first responders is very much at stake.
11.43 am
Mr. William Cash (Stone) (Con): First, I congratulate my hon. Friend the Member for Lichfield (Michael Fabricant) on an excellent speech that contained a huge amount of apparently unanswerable technical information. I also congratulate Mrs. Jean Tabernor and Mrs. Ann Edgeller, who are here today, and all those who have contributed to the magnificent movement—that is what it is—in my constituency and elsewhere in Staffordshire to save our vital service and ensure that that is done properly. That was the burden of my hon. Friend’s argument, which remains on the table. I shall be fascinated to hear what the Minister says. I have a meeting with another Minister of State at 12.15 pm; I hope that this Minister will understand that I have to go. However, I shall read what he said afterwards.
One of the most compelling arguments is about the relationship between the consequences for people caught in the impossible circumstances in which a person has a five-times better chance of being saved in Staffordshire, and the consequences for those elsewhere in the country. The constituency of the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) includes an area adjacent to mine. All her remarks about the hill farm areas are extremely important, particularly given the extreme weather conditions that can prevail up there.
I was particularly intrigued by what I thought she was saying—that the merger would not take place until the regional arrangements were up to the same standards as Staffordshire’s. I do not know where she got that from; that has not been put forward by anybody else, at least to my knowledge. I shall be happy for her to intervene and correct me on that.
Charlotte Atkins: It has been made clear that the partnership board will propose a merger when the West Midlands performance is up to the standard of Staffordshire’s. It is made clear in the partnership documents that the Staffordshire ambulance trust will have to make a decision on the merger only when that would not jeopardise patients.
Mr. Cash: No doubt the Minister can make that clear, but it is certainly not commonly understood. Whether the West Midlands service manages to maintain such standards is crucial to how the operation would be conducted and how the merger would take place. I continue to oppose the merger, and it is not just a question of medical equipment and CFRs. There are profound reasons, to do with regional arrangements that preclude a proper service for Staffordshire people. I do not believe that it will be possible, in realistic terms, for the five-times proportional difference to be made up by an improvement in the West Midlands service as a whole. I would require an enormous amount of proof to be convinced of that. There is no evidence for it; it is just an assertion. I leave it at that for the time being.
My hon. Friend raised extremely serious legal issues. To say the least, I have been extremely annoyed at the Government’s responses. I am sure that my constituents have been as well, given that I have presented two petitions in this field of endeavour with something like 5,000 signatures from my constituency alone. For example, the Government’s response to my 8 February petition to Parliament was that no observations would be issued on the petition. I find that intolerable; the Government know perfectly well what is at stake.
I repeat what I have said before, although Labour Members will take exception to it; they have in the past. During the 7 February House of Commons debate, all nine Staffordshire Labour MPs failed to support the motion opposing the merger as expressed in the terms of reference. That is on record. I should also say that on 26 February, the Conservative-controlled Staffordshire borough council passed a motion opposing the proposed merger. All the Conservatives supported the motion; none of the Labour councillors present did so. That is the record. I find the behaviour of members of the Labour party somewhat disingenuous, although I understand the reasons for it. I do not want to deprecate the reasons for it in themselves, because I am sure that Labour Members have a proper sense of duty to their constituents. However, difficult dilemmas arise, and to my mind it is clear that when the test has come, members of the Labour party—in Parliament or the local council—have, in general, supported the Government’s position. That remains a matter of record.
On the question of legality and the important matters raised by my hon. Friend the Member for Lichfield and the hon. Member for Staffordshire, Moorlands in respect of the Medicines Act 1968, there may be a solution in the hands of Government. My hon. Friend mentioned correspondence from Mr. Catling, and the hon. Lady also mentioned correspondence that is on the record. I believe that there is a procedure that could be used in a serious dispute about whether the Medicines Act and other medical legislation is applicable, but it is open to the Government to determine whether to use it; that is, to go for a declaration in the High Court, as there is clearly risk of death—my hon. Friend made that clear—and the matter of five times proportionality is very serious. I do not believe that there is the slightest chance that the West Midlands arrangements will ever come up to the standard that has been set. These are questions of great importance; of life and death.
The hon. Member for Staffordshire, Moorlands said that people were no longer prepared to take the action that they took until quite recently. Apparently, some people are not taking up the voluntary activities that they did in the past. I suspect—I do not know for sure—that the authorities in question have acquainted them with questions about insurance and negligence, and exposure even to legal action if they were to continue to provide services. So we have not only the differential in respect of potential for death as a result of the failure to make proper arrangements—that is in the hands of the Government and the trust—but the question whether the people who could provide the service have been warned off.
There are doubly good reasons why such matters should be taken up by the Government. Merely providing an opinion may or may not be sufficient. First, because the situation is serious, the Government should take leading counsel’s opinion, and that may need to be tested in the courts if we do not get the right answer.
I remain opposed to the merger. It will not work. I congratulate my hon. Friend on his expert analysis of the situation, and I concur with his conclusions. In this matter, the Labour party as a whole has failed the people of Staffordshire over an extended period. I await what the Minister has to say, but there is absolutely no evidence in anything that I have heard so far that the merger will be called off and/or that the situation for the people of Staffordshire will be materially improved in respect of the matters raised by my hon. Friend.
11.53 am
Mr. David Kidney (Stafford) (Lab): I shall try to be brief, Mr. Amess. I, too, congratulate the hon. Member for Lichfield (Michael Fabricant) on obtaining this debate on an important subject in Staffordshire at an important time. However, his blame of the trust management is ill-judged. As Staffordshire Members of Parliament, our united voices should be directed at the Minister, who should be spending time daily to sort out the problem until it is resolved.
Let us remember that Staffordshire ambulance service is the best in the country. The Government’s target is for three quarters of class A emergency calls to be responded to within eight minutes. Even in the past 12 months, Staffordshire exceeded that target every month. It usually performed at between 86 and 87 per cent. That is why it is the best performing ambulance trust in the country.
It is also why, apart from London, which was not involved in the merger configurations, Staffordshire was the only ambulance trust that was not forced into a merger with a bigger organisation. That was a recognition by even the Department of Health that it is the best performing ambulance trust in the country. Because there is now a West Midlands ambulance trust, the Government directed that the two trusts must work together to raise standards throughout the west midlands so that eventually there can be one West Midlands ambulance service. That is why a partnership direction was given, and why there is a partnership board. It is no surprise to me that issues have arisen as the practices of both trusts are examined and questions
are asked about the legality of this and the clinical effectiveness of that. A responsible board such as that of the Staffordshire ambulance service trust must take seriously allegations of clinical ineffectiveness or illegality when it decides how to respond to an outside allegation, and that is what has happened.
Several setbacks have occurred during the past six months. The service lost several patient transport contracts—that was not because of the board’s leadership or the Department but because of withdrawal of the ResQPOD. The decision was taken on clinical grounds, as my hon. Friend the Member for Staffordshire, Moorlands (Charlotte Atkins) said.
Probably the biggest single reason why Staffordshire has the best ambulance trust in the country is the excellent leadership of its former chief executive, Roger Thayne. He is a man who takes innovation to a new level, especially in the national health service. Some of the issues that he left to the ambulance trust are now occupying the time of the partnership trust. Roger himself contributed to one of the difficulties of the past six months when he questioned the legality of some of the directions given by the Department in the partnership direction, and the ambulance trust had to obtain legal advice on the issue. There was also the suggestion by a whistleblower that the trust was not collecting figures on response times properly. That has been dealt with and put to bed.
The hon. Member for Lichfield raised the latest difficulty, which affects the community first responders. The question originally was whether the seven drugs that were withdrawn in October were being held and administered illegally by volunteers, in contravention of the Medicines Act 1968. I believe that the issue has now been resolved to everybody’s satisfaction. The regulatory authority, the Department, and the regional and strategic health authorities all accept that the Act does not provide a valid objection to community first responders holding and administering those drugs. The debate has moved on to whether applicable pharmacy rules would restrict their use. That is the remaining issue, and the Minister must resolve it as soon as possible. I echo what others have said about it.
In the meantime, the ability of an absolutely brilliant arrangement in Staffordshire—it was another of Roger Thayne’s innovations to use community first responders, especially in isolated rural locations—to augment the excellence of the ambulance service is being restricted. That is causing anger, demoralisation and despondency among people who know that they can help yet have both their hands tied behind their back until the issue is resolved. That is the urgent matter in today’s debate, and that is what I want the Minister to respond to.
11.58 am
Mrs. Janet Dean (Burton) (Lab): I shall try to be brief, Mr. Amess. I congratulate the hon. Member for Lichfield (Michael Fabricant) on securing this debate.
Those of us who are not community first responders can only imagine how dispiriting it must be to attend an emergency and not be able to give the pain relief or other treatment that was available until the middle of
October. My constituent David Holt, who is the secretary of the Staffordshire community first responders, is keeping a record of all incidents in the county in which patients suffer unnecessarily. In a briefing to Alex Fox, the chairman of the South Staffordshire primary care trust, he stated that, on average, once every day since 18 October a CFR has sat helplessly with a patient for up to 45 minutes waiting for a paramedic to administer Salbutamol, GTN or Entonox. What is even more frustrating for David Holt and the first responders of Mayfield in my constituency is that over the border in Derbyshire, East Midlands ambulance service recently trained its CFRs in the use of Salbutamol and GTN spray and issued those drugs to them. Mayfield and Ellastone CFRs used the drugs for four and a half years before 18 October without any adverse incidents.
I understand from David Holt that no one from the strategic health authority or the West Midlands ambulance service has visited Staffordshire CFR groups to see how they operate. I would urge them to do so. Having said all that, I can well understand the actions that the Staffordshire ambulance service, faced with the advice that it received from the strategic health authority in October, took to ensure that the community first responders were acting legally. It now seems clear that the advice, which according to the press release issued by Staffordshire ambulance service concluded that some drugs
“were not eligible for use by lay people under the national legal framework for medicines”
“management policy falls outside the Medicines Act”,
In fact, even as long ago as July, the Medicines and Healthcare products Regulatory Agency stated in its e-mail to Staffordshire ambulance service that
“medicines legislation does not address the administration of non-parenteral medicines so there is nothing to prevent CFRs administering the remaining drug products in your letter”.
That e-mail was in response to a letter from the Staffordshire ambulance service that, I believe, listed a total of eight drugs, four of which are banned. All four of those drugs—Entonox, Salbutamol, GTN and diazepam—are non-parenteral and therefore are not covered by medicines legislation. Another two of the banned drugs that were not listed in the letter—Atrovent and Pulmicort—are also non-parenteral.
In a recent reply that I received from the MHRA, Professor Kent Woods confirms that the MHRA was not involved in the trust’s decision to withdraw the medicine. The letter clearly states:
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