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5 Dec 2006 : Column 40WH—continued

Professor Woods went on to say:

We have now gone from a question of legality to a question of the clinical governance that needs to
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operate. I know that the CFRs are willing to have tighter protocols if that means that they can relieve the pain or suffering of those they attend before a paramedic or ambulance crew arrives. I have urged Staffordshire ambulance service to reach a speedy conclusion to this unfortunate situation.

We are grateful to Ministers for listening to our concerns earlier this year. I now urge my hon. Friend to press the strategic health authority for an urgent decision on the advice that they can give to Staffordshire ambulance service. It would also be helpful if he could give a clear reassurance that it is not about a dumbing-down of the service offered to Staffordshire people and if he could put an end to the conspiracy theories that seem to be circulating.

12.2 pm

Steve Webb (Northavon) (LD): I join other hon. Members in congratulating the hon. Member for Lichfield (Michael Fabricant) on raising the issue. As we have heard from all the Staffordshire Members who have spoken so far, it is clearly an urgent issue that needs to be resolved forthwith. As the first non-Staffordshire Member to speak in the debate, I have been convinced not only today but in previous months of the quality of the service provided by the Staffordshire ambulance service. Hon. Members from the other two parties have repeatedly pressed the fact of the quality of the service in expressing their concerns about the proposed merger and I want to put on record my appreciation of all the work that is done by the paid staff of the service and the volunteers about whom we have heard today.

I find it strange, coming completely from the outside, that some fairly serious allegations are being made by the hon. Member for Lichfield, who has accused professional ambulance management of being liars and unprofessional. He clearly feels passionately about the matter. We have had some more measured contributions to the debate, too, but the key issue remains. In relation to the withdrawal of the drugs, has one ambulance service spotted something that no one else has? In a sense, that is sometimes the benefit of regional and local services; they can do things differently and if they have done so for a good reason, perhaps others should follow. I do not get any sense that, where Staffordshire ambulance service has led in terms of the withdrawal of drugs, any other ambulance trust has followed, although I am happy for the Minister to correct me on that. It seems that, although ambulance services are at liberty to consider the issue, it must not be allowed to go on.

I was interested that no one has so far referred to the letter from the chairman of Staffordshire ambulance service to the Staffordshire media, which is dated 16 November. He said:

He went on to say:

I find that quite interesting. I did not pick up from the speech made by the hon. Gentleman that the ambulance trust was saying that the measure was
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temporary. Clearly, that is what the chairman was saying in writing two or three weeks ago.

The chairman went on to say that

That is where the role of the Department of Health comes in. To some extent, the trusts are regional, devolved bodies that are charged with getting on with the job. If there is an inconsistency between what trusts are doing, if they are interpreting the law in different ways and if, potentially, patients in one part of the country are losing out, the Minister has a role to consider what is going on, the different practices and why different trusts might be getting different legal advice, and to try to provide some consistent advice to the trusts so that they can provide the same quality of care across the area.

With regard to the withdrawal of the ResQPOD, there seemed to be some discussion as to whether that was a clinical judgment, as the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) suggested. One person has judged that there might be clinical issues, and I understand from the debate that the ambulance trust has sought expert clinical advice from other people and is now considering it. That seems to me to be an entirely proper procedure. It would be wrong if any of those changes, as was intimated by the hon. Member for Lichfield, had been motivated not by clinical care but by organisational fiat or some political agenda. I was trying to work out quite what he was alleging. There were lots of hints, nudges and suggestions. I think that he was saying that the decisions are not being made because they are the right things to do or because there is some uncertainty, either about the legal position or the clinical implications, but because of forced harmonisation with the larger trusts.

Michael Fabricant: I was not saying anything like that. I was saying that I do not know why it is being done. Why are there these questions when it is apparently perfectly legal to use such things in other ambulance services? Why are ResQPODs suddenly regarded as dangerous when they are used by other ambulance services throughout the world? We do not know the reason—we can only speculate, as I said in my speech.

Steve Webb: What worries me is calling people liars and unprofessional, but only speculating on their motives. Clearly, my plea in this debate would be for transparency on the part of the trust. That is essential. The letter from which I quoted said that the decision to withdraw the drugs was

What triggered it? Who raised the issue of patient safety and what was the case? We need to know that, and whatever else has happened the trust should have been more transparent. We have some more understanding of why the ResQPOD was withdrawn. I hope that the clinical advice will be published—there is no reason why it should not be—and that the decision will be made quickly.

Transparency is important in such matters. In terms of NHS reform, the public sometimes legitimately worry that changes are being made not on a clinical basis but because of cost or some other agenda. When
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trusts are making decisions that they believe are to do with legal advice or clinical judgment, they can be open and up front about it. I do not see any reason for that not to happen.

During the debate, we heard that the hon. Member for Stone (Mr. Cash), who is no longer in his place, submitted a petition on the issue. It is disappointing when hon. Members of any party submit a petition with a large number of constituents expressing a concern and the Government decline to offer a comment. The Minister might feel that they had said all that there was to say, but it undermines our efforts as constituency MPs if we gather the views of thousands of our constituents and they are simply disregarded by the Department. I hope that the Department will consider its policy on responding to petitions and will think again about that.

We heard the hon. Member for Stafford (Mr. Kidney) praise the previous chief executive, who certainly seems to have done an outstanding job. His views have been placed on the record. The hon. Member for Staffordshire, Moorlands rightly raised the question of what has changed now, if the drugs have been used for seven years. We are talking about an Act that has been in force for 35 or more years, and that clearly has not changed, so why has the legal advice changed? What was the trigger? It comes back to my point about transparency; that is what we want. I take her point, which was also made by others, that many of the community first responders are well trained, highly skilled people who have been doing the job for a long time. I understand the frustration pointed out by the hon. Member for Burton (Mrs. Dean)—when people are on the scene, they want to do what they have been doing quite safely and they ought to be allowed to continue to do it.

In conclusion, I enter a plea for transparency from the trust. It should place on record much more fully the sequence of events that led to the two decisions. What advice did it receive, and where is it going? Will the Minister recognise the urgency that has been expressed in many of the speeches and try to resolve the inconsistencies where different legal or clinical advice has been given to ensure that the people of Staffordshire, as elsewhere, get the first-class ambulance service to which they have become accustomed?

12.10 pm

Mr. Stephen O'Brien (Eddisbury) (Con): I add my sincere congratulations to my hon. Friend the Member for Lichfield (Michael Fabricant). No Member more assiduously or ardently defends the interests of his constituents, or those of the Staffordshire ambulance service. On behalf of his constituents and of all the people of Staffordshire, he made a clear, robust and brave speech.

The reorganisation of the Staffordshire ambulance service—one of nine such reorganisations in nine years under this Labour Government—took place on the back of a spurious interpretation of Peter Bradley’s review and a sham consultation. The NHS Appointments Commission sent out letters two months
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before the end of the consultation asking for nominations for the chairmen and chairwomen of the new NHS ambulance trusts, at the request of the Department of Health. That was no doubt the process under which Messrs. Lake and Catling were appointed, as at the announcement of the merger proposal, Roger Thayne departed—to the great consternation and anxiety of the people of Staffordshire after such a wondrous spell as top guy.

One of the greatest travesties of the reorganisation was the treatment of the Staffordshire ambulance service. As I said in my response to the initial ministerial statement on the Floor of the House, the service has been put in the departure lounge. That debate was notable for the Minister’s dogged avoidance of a promise to protect the high standard of Staffordshire ambulance service.

I asked, as did my hon. Friends the Members for Lichfield, for Stone (Mr. Cash), and for South Staffordshire (Sir Patrick Cormack) and the hon. Member for Cannock Chase (Dr. Wright), for an assurance that no merger would take place until the West Midlands ambulance service trust had reached the standards of the Staffordshire ambulance service. No such assurance was given. It is increasingly plain to see why. It cannot or will not get there.

We warned and warned again. My hon. Friend the Member for Lichfield was too generous to the Government and the Department. They were warned, so the tragic consequences for the people of Staffordshire about which we have heard today cannot, by definition, be unintended. To ram something through, as the Department of Health has done with its mergers, despite being warned of the consequences that would inevitably flow from the change, means that Ministers intended the damaging consequences that have resulted. Unless they can account for themselves, they have no escape other than to be damned by their actions.

On the other hand, MPs across the House were reassured by the Minister’s promise to the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) when she asked him to confirm that

However, his answer turned out to be just warm words. Barely three months later, my hon. Friend the Member for Lichfield came across a leaked e-mail that made it clear that operational independence was being eroded by the very ministerial team that gave the guarantee. The e-mail, signed by a senior civil servant on behalf of the Secretary of State for Health, stated that the chief executive of the West Midlands ambulance service must now be invited to board meetings of the Staffordshire ambulance service and that his “advice” must be taken in all important decisions. In addition, there would be joint control of personnel, finance and IT functions. By reneging on his promise to protect Staffordshire’s operational independence, the Minister has reneged on his promise that the Government


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The Staffordshire ambulance service is slowly being undermined, and the decisions spoken of in today’s debate carry the inevitable suspicion that it is being levelled down to the overall standard of the rest of the area under the West Midlands ambulance trust, bearing in mind Staffordshire’s consistent pre-eminent position at the top of all score sheets before the merger proposals were made.

At the time of the announcement, I and others demanded that if the West Midlands ambulance service had not reached the standard of Staffordshire within the arbitrary two years set out by the Minister, no merger should go ahead. The Home Secretary had guts enough to scrap the totally misconceived police mergers, but the Secretary of State for Health has been found wanting in every respect when faced with exactly the same choice.

Although the Minister would not accede outright to the merger not going ahead, he intimated to the hon. Member for Burton (Mrs. Dean) that the two-year time frame was not set in concrete should more time be needed for the West Midlands ambulance service to come up to scratch. However, it is clear that the current chief executive of Staffordshire ambulance service wants to speed up the process, and he appears to be under pressure from the Department. He said in the summer:

Mrs. Dean: Will the hon. Gentleman give way?

Mr. O'Brien: I do not have the time, and the hon. Lady has already made her point in trying to defend the current management. Without taking the necessary steps to improve West Midlands ambulance service, the only way to speed up the process is actively to dumb down Staffordshire.

As we have heard, the ResQPOD was withdrawn, apparently on safety grounds. Every ambulance and paramedic car in Staffordshire carried one, but the West Midlands ambulance service does not use them. In addition, there have been fears that the LUCAS, often called the thumper, will similarly be banned—another device not used by West Midlands ambulance service. According to the NHS, people are four and a half times more likely to survive a severe heart attack in Staffordshire than in the rest of the west midlands because of the speed of response of the Staffordshire ambulance service and the community first responders and because of the training and equipment available to Staffordshire ambulance paramedic crews. Attempts to portray that decision as clinical fly in the face of the evidence—and, frankly, of reason. To say that it was done for reasons of safety is plainly a smokescreen for the politics of merger.

The latest development was the withdrawal on 18 October of seven of the 13 drugs administered by the community first responders. The trust invoked the Medicines Act 1968 to support that decision, but again a leaked e-mail from the Department of Health to the trust—I believe that it was sent on 26 July—saw no problem with all 13 medicines being administered by CFRs. My hon. Friend the Member for Stone
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mentioned an action for declaration if there was any question of doubt; the Minister has that within his gift and could order it today.

My hon. Friends in Staffordshire, the volunteer staff of Staffordshire ambulance service and the people of Staffordshire are having to fight tooth and nail to protect their ambulance service and community first responders. Patient choice was ignored with a sham consultation, and it continues to be ignored by bureaucrats bent on delivering a political and financial agenda rather than a clinical one. The Minister’s civil servants and the new chief executive of Staffordshire ambulance service need to account for the fact that they have not been able to keep the Minister’s promise to protect the people of Staffordshire by keeping their ambulance service at the level that they have enjoyed in the past, without suffering compromise in order to merge with the West Midlands ambulance service. It is right to ask the Minister: what has changed?

12.18 pm

The Minister of State, Department of Health (Andy Burnham): I, too, congratulate the hon. Member for Lichfield (Michael Fabricant) on securing this debate. I do not doubt his sincerity and strength of feeling on the matter. I also congratulate my hon. Friends the Members for Staffordshire, Moorlands (Charlotte Atkins), for Stafford (Mr. Kidney) and for Burton (Mrs. Dean) on their contributions to the debate. If every organisation in the NHS inspired such civic pride and as much interest and energy as the Staffordshire ambulance service, we would be in a good place.

The concerns expressed this morning are understandable, because the ambulance service provides the first point of access to health care for a wide variety of patient conditions, ranging from life-threatening emergencies to chronic illness and social care. The 12 NHS ambulance service trusts in England are the first and often the most important contact for the 6 million 999 callers each year. Of course, it is vital that patient care is not only safe but of a high quality. There has been a rising demand for the ambulance service. The latest figures for 2005-06 show 6 per cent. more calls than in the previous year and a 5 per cent. increase in the number of incidents attended. Despite that, improvements in response time continue.

I, too, take the opportunity to pay tribute to the hard work and dedication of staff at the ambulance service, including community first responders. Not long ago, I was a patient of the Staffordshire ambulance service, as I mentioned to my hon. Friend the Member for Burton. I had an accident on the M6, somewhere in the constituency of my hon. Friend the Member for Stafford. I was involved in a collision between a Government car and a foreign lorry. Even though the service knew I was a Government Minister, I was looked after very well indeed, which shows the professionalism and skill of the service.


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