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“twice...helped ambulance bosses reach their target times for Category A calls, and both times the ambulance wasn’t needed.”
The emergency care practitioners were able to assess the situation in a way that allowed better management of resources.
Obviously, I very much hope that that innovation will improve matters. The use of emergency care practitioners has only just started, so we do not yet know what effect they will have, but the article also discovered that ambulances from the Forest of Dean were
“having to wait outside Gloucestershire Royal Hospital for up to two hours to drop off patients on a Sunday.”
I accept that a Sunday is not necessarily a peak period, but the article shows that accident and emergency units at the hospital are running at capacity, and that there is little slack in the system.
The ambulance trust is also trying to use the fire and rescue service, and others, to deliver community responders. The scheme has been running for some time, and does not seem to have improved performance to any great extent. I support the idea, but my caveat is that it must be in addition to the existing service. It should not be used to replace ambulance cover where that is appropriate, and nor should it be used to massage the figures.
I turn now to performance measurement. The current system for measuring response times is misleading because it overstates, rather than understates, the ambulance trust’s performance. That may be surprising, given the appalling performance that I have outlined but, at the moment, the clock starts running when three pieces of information have been received—the nature of the complaint, the address of the patient, and a contact number.
Sometimes, all those pieces of information will not be gathered until the ambulance has arrived. Last year, there were 45 incidents in the Forest when, according to the statistics, an ambulance responded before it was recorded as having been called. The statistics may look pretty appalling, but they actually show an artificially improved reality.
Next year, the call-connect system will be introduced, with the clock starting the second that a call is received. That will lead to an immediate downturn in the statistics, but they will give a more accurate representation of the
trust’s performance. Most constituents start measuring the wait for an ambulance from the minute that they get through to the call centre after dialling 999. Although the new system will provide more realistic figures, the performance will look even worse than it does at present.
It is clear that ambulance coverage in the Forest of Dean is not good enough. The matter was raised last year with the Minister and, despite the assurances, the service has gone backwards. There appeared to be some significant problems with staff being taken through the changes. My constituents deserve, from the taxes that they pay, equitable service with the rest of the county. I hope that we will experience a dramatic improvement in performance in the next year, otherwise I assure the Minister that, with the leave of Mr. Speaker, we will be back at the same time in the same place to discuss exactly the same subject next year.
7.19 pm
The Minister of State, Department of Health (Caroline Flint): I congratulate the hon. Member for Forest of Dean (Mr. Harper) on securing the debate. I do not know whether it is good or bad that the same Minister who replied last time is here again today. Obviously, I was keen to read the previous debate to ascertain what had changed between then and now so that I could provide as good a response as possible.
The hon. Gentleman raised several specific issues, which I shall try to tackle, but I shall ensure that information on some questions is provided by those responsible for the services in his area.
I pay tribute to the staff in Gloucestershire, especially the staff of the Great Western Ambulance Service NHS Trust, for the hard work they put into delivering local services. I listened carefully to the hon. Gentleman’s remarks about the comments on the blog site. Clearly, it is important to listen and I hope that those who manage services are examining the site to ascertain whether their substantial engagement is being shared and understood by those who deliver the services.
Since we last debated the matter, considerable investigation and planning of different ways in which services could be provided to deliver a better service across the piece has taken place. The specific challenges that the Forest of Dean presents have been better appreciated. Providing a better service for the future is also being considered—I shall go into that in more detail shortly.
I appreciate the hon. Gentleman’s point that some of the timings appear to have gone in the other direction since last year. However, having examined the previous debate in preparation for today’s debate, I believe that efforts have been made to tackle the problem. Although the current figures clearly need to be improved, I hope that I can give some examples that will reassure the hon. Gentleman and his constituents that the direction is now the right one.
Ambulance trusts are the first and often the most important contact for the 6 million people who call 999 each year. The range of care that they provide is clearly expanding to take health care to patients who need an emergency response, and to provide urgent advice or treatment to patients who are less ill and care to those
whose condition or location prevents them from travelling easily to access health care services.
We all appreciate that the sort of services that ambulances provide—and others such as emergency care responders and community care responders—are a long way from those that were available 20 years ago. People who need treatment want it to start as soon as the ambulance arrives. They do not necessarily want to wait until they get to hospital for treatment. That is important.
Clearly, resources are also important. Spending on ambulance services has increased, with ambulance trust expenditure reaching £1.45 billion in 2005, compared with just under £620 million in 1997. That is a rise of 135 per cent., which has helped improve services.
The Government have set a standard that at least 75 per cent. of all ambulance trust 999 calls from patients with immediate life-threatening conditions should have an ambulance respond to them in eight minutes. I am pleased to tell the House that the planned resources for the Forest of Dean area for 2007-08 will mean an increase in staff from 29 to 39 full-time equivalents. There will be an increase from three ambulances working 24/7 in 2006-07 to four daytime ambulances and two night-time ambulances in 2007-08. Six emergency care practitioners will also be provided. I hope that that shows that what I said in the previous debate about planning and using resources is happening. The plans will take effect from the next financial year, despite some of the challenges posed by deficits in the area. As we know, performance has improved over recent years, but we cannot be complacent. We also know that 98 per cent. of patients are overwhelmingly satisfied with the care that they receive.
I appreciate the hon. Gentleman’s concern that response times in his constituency to immediately life-threatening calls are currently too low. The Department collects data at trust level rather than by geographical area. Ambulance trust directions issued in July 2006 required each trust to ensure that information in respect of its performance is recorded, collated and published for the trust and each of the trust's local areas. That ensures a level of not only transparency but accountability, which is important.
Our latest published figures for the trust indicate that, as at 2005-06, 74 per cent. of immediately life-threatening calls were met by the Great Western Ambulance Service NHS Trust, but as the hon. Gentleman has said, the response rate in the Forest of Dean has been low. It appears that it has gone in a slightly different direction from the lower figures that he mentioned in the previous debate. However, there are plans to raise performance across Gloucestershire to the national target levels by September this year.
Mr. Harper: I was particularly concerned, having looked at the figures for the Great Western Ambulance Service NHS Trust across the three areas—Wiltshire, Gloucestershire and Avon. The most worrying thing in the move between 2005-06 and 2006-07 is that the performance has deteriorated across category A, B and C areas. It does not seem that there is a problem just in the Forest of Dean. There is a problem across the trust in meeting its targets.
Caroline Flint: I am sure that those responsible for services in the area are mindful of that. That is why I would like to explore as part of my contribution what is taking place not just in the Forest of Dean but in the area as a whole.
The hon. Gentleman said that the new system under call-connect will give a greater sense of what is or is not happening at the most local level. Changes to clock start will be implemented from 1 April 2008. That is important. It will mean a better experience for patients, shorter waits for the phone to be answered and help to arrive and, I hope, improved outcomes, meaning more lives will be saved.
Ambulance trusts have embarked on a programme of service improvement. I understand that the Great Western Ambulance Service NHS Trust is changing its resource deployment. I mentioned earlier the increases in staff, ambulance provision and emergency care practitioners for the Forest of Dean, but of course that is being looked at across the trust as a whole.
In rural areas the trust is moving to embedding ambulance practitioners within the Community, and I am advised that the Forest now has dedicated emergency care practitioner resources in Lydney. A second scheme is due to commence later in 2007 in Cinderford. Deployment of that type of resource allows for increasing numbers of patients to be treated nearer to home, avoiding long and unnecessary journeys to hospital. It also enhances the quality of the experience for the patient. Emergency care practitioners are also able to forge closer links with local general practitioners and community health teams further to enhance emergency and urgent care in communities.
The changing model in urban areas will see increased use of ambulance practitioners as solo responders, deployed proactively to identify priority locations. That increase in solo capacity will reduce the need to utilise Forest-based resources in the urban areas. That point was of concern to the hon. Gentleman in the previous debate. I think that that has been taken on board as a way of improving and modernising services. That will support the improvement required in the Forest, as well as in the high-activity areas. That model has commenced in the past two weeks and has produced the anticipated improvement in response times, with Gloucestershire reporting over 75 per cent. for three consecutive days last week. Clearly, we cannot be complacent about those figures and we must recognise that there are still issues around the low performance rate in the Forest of Dean, but that indicates a step in the right direction.
Resources are important. To support trusts with improvements such as those, the Department made £25 million in capital available to trusts this year to enable them to fund service delivery and infrastructure changes to go further and faster in improving performance. Underpinning all that is a developing work force who are being used to the best effect, and who are at the very heart of realising true transformation in the way care is delivered.
Driving that forward requires a different blend of skills and experience. For some staff, that will involve change, but it is about recognising the changes that are necessary to deliver the best service for everyone, not forgetting that sometimes staff may need those services
and will want the best for themselves as patients, as well for the patients whom they serve. But again, contributing to that draws on the creativity of front-line staff.
Community responders are clearly also a way of saving lives. New ways of working and modernisation can contribute to further improvement. Community responders are trained in basic life support and first aid and equipped with defibrillators. With emergency care practitioners, they can do more faster, and in some cases better.
In order to improve first response performance, the trust has launched two community responder schemes at Coleford and Lydney in partnership with Gloucestershire fire and rescue service. I am informed that those schemes went live on 6 December 2006. They are trained in special access techniques such as line rescue, which further enhances the joint capability within the Forest. I understand that community first responder teams have also continued to expand with a further 15 responders being trained this month. The two teams that I mentioned in my last speech have gone live in Cinderford and Newent, so I am pleased that something that I said last time round has actually happened.
The trust is also concentrating on business and leisure facilities, as well as schools, in order to embed life-saving skills and automatic external defibrillators into these environments. I am sure that the hon. Gentleman will agree that that is a good way to consider how we can differently provide better services for the future, particularly in places such as the Forest of Dean. Community defibrillation officers in the former Avon, Gloucestershire and Wiltshire area were awarded funding of £90,000 over a three-year period, and received 201 automated external defibrillators.
The reconfiguration of ambulance trusts has meant that we are in a position to start accelerating planning and delivering a better service. It will give trusts the capacity and capability to improve standards and deliver world-class services. However, delivering change on the scale that is needed takes time. NHS ambulance trusts have more money than ever before with 135 per
cent. more resources than in 1997. Now that the new management teams and structures are in place I am confident that services will improve. I am sure that the hon. Gentleman will look in detail at what planning has already been provided for and what changes are already happening, and keep them under close scrutiny to ensure that they deliver the outcomes that he cares so strongly about.
The hon. Gentleman mentioned the matrix system, which also came up in our last debate. That has proved helpful, but parts of it have clearly acted against some of his concerns, particularly about rural areas. An improved computer-aided dispatch system went live today and automatic vehicle location systems will come on line in June. That will provide better real time evidence about the volume of calls and the demands on different services, which will allow the planners better to match what is needed in different parts of his trust’s area. Additional response cars have been provided in Gloucester and Cheltenham to support the matrix system and prevent resources from being constantly called out of the Forest of Dean. Again, that was a concern in our last debate, since when progress has been made, which I am pleased and reassured about.
I hope that the hon. Gentleman will agree that improvements have been made at both national and local level. The dedication and skills of ambulance staff have made that possible and their continued efforts will turn into reality the improvements that we aim to continue to deliver.
I encourage the hon. Gentleman to continue his support for his local NHS services in their commitment to deliver and maintain high quality service, and join with those who have to make the positive argument that change is not always bad. It is often for improved services and opportunities for staff to engage in a way that they may not have been allowed to do or able to do in the past.
Adjourned accordingly at twenty-seven minutes to Eight o’clock.
Deferred Divisions
That the draft Integration Loans for Refugees and Other Regulations 2007, which were laid before this House on 21st February, be approved.
The House divided: Ayes 342, Noes 49.
AYES
Afriyie, Adam
Ainger, Nick
Ainsworth, rh Mr. Bob
Anderson, Mr. David
Anderson, Janet
Atkinson, Mr. Peter
Austin, Mr. Ian
Bacon, Mr. Richard
Bailey, Mr. Adrian
Baird, Vera
Baldry, Tony
Balls, Ed
Banks, Gordon
Barker, Gregory
Barlow, Ms Celia
Baron, Mr. John
Barron, rh Mr. Kevin
Battle, rh John
Bayley, Hugh
Begg, Miss Anne
Bell, Sir Stuart
Benn, rh Hilary
Benyon, Mr. Richard
Berry, Roger
Blackman, Liz
Blackman-Woods, Dr. Roberta
Blears, rh Hazel
Blunkett, rh Mr. David
Blunt, Mr. Crispin
Bone, Mr. Peter
Boswell, Mr. Tim
Bottomley, Peter
Bradshaw, Mr. Ben
Brady, Mr. Graham
Brazier, Mr. Julian
Brokenshire, James
Brown, Lyn
Brown, Mr. Russell
Browne, rh Des
Browning, Angela
Bryant, Chris
Burgon, Colin
Burnham, Andy
Burns, Mr. Simon
Burrowes, Mr. David
Burt, Alistair
Butler, Ms Dawn
Butterfill, Sir John
Byers, rh Mr. Stephen
Cairns, David
Cameron, rh Mr. David
Campbell, Mr. Alan
Campbell, Mr. Gregory
Carswell, Mr. Douglas
Caton, Mr. Martin
Cawsey, Mr. Ian
Challen, Colin
Chaytor, Mr. David
Clapham, Mr. Michael
Clappison, Mr. James
Clark, Greg
Clark, Ms Katy
Clark, Paul
Clarke, rh Mr. Charles
Clifton-Brown, Mr. Geoffrey
Clwyd, rh Ann
Coaker, Mr. Vernon
Coffey, Ann
Connarty, Michael
Conway, Derek
Cook, Frank
Cooper, Rosie
Cooper, Yvette
Cormack, Sir Patrick
Cox, Mr. Geoffrey
Crabb, Mr. Stephen
Crausby, Mr. David
Creagh, Mary
Cummings, John
Cunningham, Mr. Jim
Curry, rh Mr. David
Darling, rh Mr. Alistair
David, Mr. Wayne
Davidson, Mr. Ian
Davies, Mr. Dai
Davies, Philip
Dean, Mrs. Janet
Denham, rh Mr. John
Devine, Mr. Jim
Dhanda, Mr. Parmjit
Dismore, Mr. Andrew
Djanogly, Mr. Jonathan
Dobbin, Jim
Dobson, rh Frank
Donohoe, Mr. Brian H.
Doran, Mr. Frank
Dowd, Jim
Duddridge, James
Duncan, Alan
Dunne, Mr. Philip
Eagle, Angela
Eagle, Maria
Efford, Clive
Ellman, Mrs. Louise
Ellwood, Mr. Tobias
Evans, Mr. Nigel
Fabricant, Michael
Fallon, Mr. Michael
Farrelly, Paul
Field, rh Mr. Frank
Field, Mr. Mark
Fitzpatrick, Jim
Flello, Mr. Robert
Flynn, Paul
Follett, Barbara
Foster, Mr. Michael (Worcester)
Foster, Michael Jabez (Hastings and Rye)
Fox, Dr. Liam
Francois, Mr. Mark
Gale, Mr. Roger
Gauke, Mr. David
Gerrard, Mr. Neil
Gibb, Mr. Nick
Gibson, Dr. Ian
Godsiff, Mr. Roger
Goggins, Paul
Goodman, Mr. Paul
Goodwill, Mr. Robert
Gove, Michael
Gray, Mr. James
Green, Damian
Greening, Justine
Greenway, Mr. John
Grieve, Mr. Dominic
Griffith, Nia
Grogan, Mr. John
Gwynne, Andrew
Hague, rh Mr. William
Hain, rh Mr. Peter
Hall, Mr. Mike
Hall, Patrick
Hamilton, Mr. David
Hammond, Mr. Philip
Hammond, Stephen
Hands, Mr. Greg
Hanson, rh Mr. David
Harper, Mr. Mark
Harris, Mr. Tom
Heald, Mr. Oliver
Healey, John
Henderson, Mr. Doug
Hendry, Charles
Heppell, Mr. John
Hesford, Stephen
Hill, rh Keith
Hillier, Meg
Hoban, Mr. Mark
Hodgson, Mrs. Sharon
Hollobone, Mr. Philip
Hood, Mr. Jimmy
Hoon, rh Mr. Geoffrey
Howarth, rh Mr. George
Hoyle, Mr. Lindsay
Hughes, rh Beverley
Humble, Mrs. Joan
Hurd, Mr. Nick
Hutton, rh Mr. John
Iddon, Dr. Brian
Illsley, Mr. Eric
Ingram, rh Mr. Adam
Irranca-Davies, Huw
Jack, rh Mr. Michael
Jackson, Mr. Stewart
Johnson, rh Alan
Johnson, Ms Diana R.
Jones, Helen
Jones, Lynne
Jowell, rh Tessa
Joyce, Mr. Eric
Kaufman, rh Sir Gerald
Kawczynski, Daniel
Keeley, Barbara
Kelly, rh Ruth
Kemp, Mr. Fraser
Khabra, Mr. Piara S.
Khan, Mr. Sadiq
Kidney, Mr. David
Kirkbride, Miss Julie
Knight, rh Mr. Greg
Ladyman, Dr. Stephen
Lait, Mrs. Jacqui
Lancaster, Mr. Mark
Laxton, Mr. Bob
Lazarowicz, Mark
Lepper, David
Lewis, Mr. Ivan
Lewis, Dr. Julian
Lidington, Mr. David
Lilley, rh Mr. Peter
Linton, Martin
Lloyd, Tony
Loughton, Tim
Love, Mr. Andrew
Lucas, Ian
Luff, Peter
Mackay, rh Mr. Andrew
MacShane, rh Mr. Denis
Mahmood, Mr. Khalid
Malik, Mr. Shahid
Mallaber, Judy
Mann, John
Maples, Mr. John
Marsden, Mr. Gordon
Marshall, Mr. David
Martlew, Mr. Eric
May, rh Mrs. Theresa
McAvoy, rh Mr. Thomas
McCabe, Steve
McCarthy, Kerry
McCarthy-Fry, Sarah
McCartney, rh Mr. Ian
McCrea, Dr. William
McFall, rh John
McGovern, Mr. Jim
McGrady, Mr. Eddie
McIntosh, Miss Anne
McIsaac, Shona
McKechin, Ann
McKenna, Rosemary
McLoughlin, rh Mr. Patrick
McNulty, Mr. Tony
Mercer, Patrick
Merron, Gillian
Michael, rh Alun
Milburn, rh Mr. Alan
Miliband, rh David
Miliband, Edward
Miller, Andrew
Milton, Anne
Mitchell, Mr. Andrew
Moffat, Anne
Moffatt, Laura
Mole, Chris
Morgan, Julie
Mullin, Mr. Chris
Munn, Meg
Murphy, Mr. Jim
Naysmith, Dr. Doug
Neill, Robert
Newmark, Mr. Brooks
Norris, Dan
O'Brien, Mr. Stephen
O'Hara, Mr. Edward
Olner, Mr. Bill
Osborne, Mr. George
Palmer, Dr. Nick
Paterson, Mr. Owen
Pearson, Ian
Pelling, Mr. Andrew
Pickles, Mr. Eric
Plaskitt, Mr. James
Prentice, Bridget
Prentice, Mr. Gordon
Prescott, rh Mr. John
Prisk, Mr. Mark
Prosser, Gwyn
Purnell, James
Rammell, Bill
Randall, Mr. John
Reed, Mr. Andy
Reed, Mr. Jamie
Reid, rh John
Rifkind, rh Sir Malcolm
Riordan, Mrs. Linda
Robathan, Mr. Andrew
Robertson, Hugh
Robertson, John
Rooney, Mr. Terry
Roy, Mr. Frank
Ruane, Chris
Ruddock, Joan
Russell, Christine
Salter, Martin
Sarwar, Mr. Mohammad
Scott, Mr. Lee
Seabeck, Alison
Selous, Andrew
Shapps, Grant
Shaw, Jonathan
Sheerman, Mr. Barry
Sheridan, Jim
Simmonds, Mark
Simpson, Alan
Simpson, David
Simpson, Mr. Keith
Skinner, Mr. Dennis
Slaughter, Mr. Andy
Smith, Ms Angela C. (Sheffield, Hillsborough)
Smith, Geraldine
Smith, rh Jacqui
Snelgrove, Anne
Southworth, Helen
Spelman, Mrs. Caroline
Spink, Bob
Spring, Mr. Richard
Starkey, Dr. Phyllis
Stoate, Dr. Howard
Strang, rh Dr. Gavin
Straw, rh Mr. Jack
Streeter, Mr. Gary
Stringer, Graham
Sutcliffe, Mr. Gerry
Swayne, Mr. Desmond
Swire, Mr. Hugo
Syms, Mr. Robert
Tami, Mark
Tapsell, Sir Peter
Taylor, David
Thomas, Mr. Gareth
Thornberry, Emily
Timms, rh Mr. Stephen
Tipping, Paddy
Todd, Mr. Mark
Touhig, rh Mr. Don
Trickett, Jon
Truswell, Mr. Paul
Turner, Dr. Desmond
Turner, Mr. Neil
Tyrie, Mr. Andrew
Ussher, Kitty
Vara, Mr. Shailesh
Viggers, Peter
Villiers, Mrs. Theresa
Vis, Dr. Rudi
Walker, Mr. Charles
Wallace, Mr. Ben
Walley, Joan
Walter, Mr. Robert
Waltho, Lynda
Ward, Claire
Wareing, Mr. Robert N.
Waterson, Mr. Nigel
Watkinson, Angela
Watson, Mr. Tom
Watts, Mr. Dave
Whitehead, Dr. Alan
Whittingdale, Mr. John
Wicks, Malcolm
Wiggin, Bill
Williams, rh Mr. Alan
Williams, Mrs. Betty
Wilson, Mr. Rob
Wilson, Sammy
Winnick, Mr. David
Winterton, Ann
Winterton, Sir Nicholas
Winterton, rh Ms Rosie
Woodward, Mr. Shaun
Wright, Mr. Anthony
Wright, David
Wright, Mr. Iain
Wright, Jeremy
Wright, Dr. Tony
Wyatt, Derek
Yeo, Mr. Tim
Young, rh Sir George
NOES
Alexander, Danny
Baker, Norman
Barrett, John
Brake, Tom
Breed, Mr. Colin
Brooke, Annette
Browne, Mr. Jeremy
Bruce, rh Malcolm
Burstow, Mr. Paul
Burt, Lorely
Cable, Dr. Vincent
Campbell, rh Sir Menzies
Clegg, Mr. Nick
Corbyn, Jeremy
Davey, Mr. Edward
Drew, Mr. David
Farron, Tim
Gidley, Sandra
Hancock, Mr. Mike
Harris, Dr. Evan
Harvey, Nick
Heath, Mr. David
Hemming, John
Hermon, Lady
Holmes, Paul
Hosie, Stewart
Howarth, David
Hughes, Simon
Laws, Mr. David
Leech, Mr. John
Llwyd, Mr. Elfyn
Mulholland, Greg
Öpik, Lembit
Price, Adam
Reid, Mr. Alan
Rennie, Willie
Rogerson, Mr. Dan
Rowen, Paul
Russell, Bob
Sanders, Mr. Adrian
Smith, Sir Robert
Stunell, Andrew
Swinson, Jo
Taylor, Matthew
Teather, Sarah
Vaz, rh Keith
Webb, Steve
Weir, Mr. Mike
Williams, Mr. Roger
Williams, Stephen
Willis, Mr. Phil
Willott, Jenny
Question accordingly agreed to.
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