HC Deb 23 April 1970 vol 800 cc773-82

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Hamling.]

10.18 p.m.

Mr. Timothy Kitson (Richmond, Yorks)

I welcome an opportunity to raise on the Adjournment the subject of the road accident after-care scheme in the North Riding. In 1966 some 8,000 people died as a result of road accidents, 2,000 of them at the site of the accident and 2,000 of them between the site and arriving at a hospital.

In 1967 it was suggested by a general practitioner that a scheme might be introduced to deal with road accidents in the North Riding of Yorkshire, and a meeting was called of local general practitioners, police, ambulance, fire services, local authorities and hospitals. A steering committee was set up to sort out problems involved in road accidents and discuss better communications and the introduction of better equipment. The scheme was registered as a charity. It went into operation in December, 1967.

The area covered by the scheme stretching from Barnard Castle, Darlington and Hawes down to Boroughbridge and Thirsk and covering 1,500 square miles. The Al and the A66 run through the centre of the area, and those participating in the scheme are the services which I have mentioned.

The section of the Al covered by the scheme is extremely dangerous. There are 170 miles of motorway from London to Doncaster to the South, there is a motorway running from Darlington to Newcastle to the North, and many travellers treat this section of the Al as a motorway.

During the last 18 months, 450 accidents of a variety of types have been dealt with by 34 general practitioners who are now involved in the scheme.

It is a unique scheme in which people are greatly interested. The enthusiasm from local authorities and local people has been tremendous. Within two years £6,000 has been raised to improve the equipment carried not only by the general practitioners involved in the scheme, but also by the police and ambulances.

Police cars now carry, in addition to the usual equipment, spinal boards, large dressings, positive-pressure breathing apparatus and " airways " to clear the air passage.

The medical office of health has equipped the ambulances with inflatable splints, which are easily stored, rapidly applied, and comfortable in use, large dressings made by boys from a school for the disabled, spinal boards, and other equipment.

The doctor going to an accident has a large " Doctor " sign on top of his motor car which flashes like a normal police car. He also carries a camera to take pictures, where possible, of accidents, as the scheme is trying to build up records of the seriousness of accidents on this section of the road.

The accident service is co-ordinated from police headquarters. Some general practitioners' cars are fitted with two-way radios on the ambulance service wavelength so that they can be reached rapidly. On average, during the last 15 months, a doctor has been on the scene of an accident in 9.7 minutes, whilst the ambulance, which usually has a longer distance to travel, has taken about 16 minutes.

What is so gratifying about the scheme is the enthusiasm of doctors, surgeons, police, ambulance, fire brigades and local authorities who have all worked together to make the scheme a success. On the success of this scheme, new schemes are being started in Beverley, Hull and Oxfordshire. Many people from all over the country last winter attended a symposium which was held at Scotch Corner in which many local authorities took a great deal of interest.

I ought to clear up one matter. Last week, when I was discussing this matter, a report in the Press stated that a constituent of mine had been certified dead by ambulance men attending the scene of an accident. This was incorrect. My constituent had been thought to be dead and had been covered by a blanket, but when the doctor and ambulance service arrived they started to work on him and he was taken to hospital. He is now back at work, completely recovered. I should like to say how sorry I am for any embarrassment that may have been caused to the ambulance service over a misunderstanding arising from a conversation which I had with a Lobby correspondent.

I should like to see co-ordination between the Ministry of Health, the Home Office and the Ministry of Transport. We know that this scheme is a success, and we are very disappointed by the report which was prepared for the Department of Health by Dr. Peter Parish. This report, quite frankly, was an insult to all those working in this scheme.

I consider that the statistics he used were very unfair to evaluate the usefulness of the scheme. Up to now there has been no access to hospital records and it has been difficult for G.P.s to use a standard pro forma form for completion on accidents. How can the success of the scheme be properly evaluated until a proper record is kept of all the cases treated by the road accident after-care scheme?

A clinical research committee consisting of hospital consultants and general practitioners was formed in January, 1969, and a pro forma was designed for completion by the police, G.P.s and hospital staff. All ambulance, police and fire records are filed at the respective headquarters but so far no overall coordination of these findings has been carried out. Surely, if time in hospital can be saved and disability in later life reduced, this scheme is working and saving the nation money.

This is one of the main objects of the scheme and we believe that with the experience and the improvement in dealing with the injured at the scene of the accident, time must, and will, be saved in hospital.

I mentioned the support of the local authorities and I should like to mention two letters which I have received. One from the Richmond Rural District Council states: This Council has been associated with the Road Accident After-care Scheme from its inception … the Council was an early financial contributor and has undertaken work for the Committee which has had the scheme in hand. The trunk roads Al and A66 pass through this district and are well known for the volume of traffic which they carry. The other highways serving the district are also very busy with industrial, commercial, residential and tourist traffic. The Council has been most surprised to read … that the Ministry of Health has said that no money can be given yet from the national purse for this scheme. The Council knows that you are to raise this question in the House of Commons and the members have asked me to let you know that it will support everything you can do to ensure that national funds are made available for the Road Accident After-care Scheme. The doctors and all others who have participated in the scheme to date should be commended by the Government's acceptance of responsibilities and contributing the money needed to keep the scheme running. This Council and others who live astride trunk roads could easily say that those persons who use the trunk roads from the North, South, East and West of England are not their responsibility when it comes to an accident. We feel that the attention of the Government might be drawn to the parable of the Good Samaritan. There is a very similar letter from the Northallerton Rural District Council expressing the hope that the Government will feel in some way able to support the scheme. Having seen it in operation I seriously believe that general practitioners must be recognised as an accepted part of the rescue team. The World Health Organisation reports over many years have advocated the importance of medical attention at the scenes of road accidents and this scheme is meeting these requirements.

The fact is that the Ministry does not accept the necessity of a doctor going to the scene of the accident as an item of service. There is no responsibility to the patient until he is admitted to hospital. I feel that this should be altered. This pilot scheme is, I believe, the forerunner of something that in years to come will be accepted by the nation as essential. I should like to hear the Minister encourage those working in this area for the splendid effort which they have made to date and I should like to see his Department coordinating discussions with other Ministries to see what assistance can be given to them in the years ahead.

10.29 p.m.

Mr. Maurice Macmillan (Farnham)

I would like to thank my hon. Friend the Member for Richmond, Yorks (Mr. Kitson) for bringing this development in saving life and human suffering to the attention of the House and to congratulate all those whose vision, energy and faith have brought it into being. I hope that the Joint Under-Secretary will be able to see his way to encouraging and supporting this pilot scheme and, in cooperation with his appropriate colleagues, at least ensure that some proper follow-up of the findings takes place, with a more complete evaluation.

I feel that it is this type of individual initial inspiration, with its enthusiastic co-operative effort, which starts off what so often becomes a vital part of our services, particularly with the emphasis on prevention.

I hope that the Minister will not be deterred by any small extra cost which might be involved in the short term, because this is a question of saving not only life, but hospital time, scarce resources, skill, and equipment, and therefore, ultimately, money.

10.30 p.m.

Dr. Reginald Bennett (Gosport and Fareham)

As one who lived for 10 years or more in the North Riding, I am struck with admiration for the enterprise and thoughtfulness of these people who have got together to render a public service which notably fills a gap which has not so far been tackled and met elsewhere in the country. I add my words, few as they are, to the words of my hon. Friends in hoping that the Government will be able to approve and support this unusual endeavour.

The Joint Under-Secretary of State for the Department of Health and Social Security (Dr. John Dunwoody)

I am grateful to the hon. Member for Richmond, Yorks (Mr. Kitson) for raising the subject of the Catterick Accident After-Care Centre tonight. This represents a degree of co-operation between the different services involved that is thoroughly commendable: and everyone must be completely in sympathy with the aims of the road accident after-care scheme in the Richmond-Catterick area of the North Riding of Yorkshire. There is, of course, no argument about the need to save life and to aid those injured in road accidents as quickly as possible, and I congratulate Dr. Easton and his colleagues, medical and otherwise, for giving so much time, entirely voluntarily, to a scheme covering a considerable length of the Al and A6 routes, and for the euthusiasm and humanity of their enterprise. I say this not only from the point of view of my Department, but of having had some experience in dealing with this problem on the main roads in a tourist area during the tourist season.

I might add that, prima facie, this is a most promising project and that I welcome the initiative of those concerned in endeavouring to demonstrate its value. One does not, of course, want to exaggerate what a scheme of this kind can hope to achieve. It would be unfair to expect very dramatic results. Doctors and ambulance men and indeed all the others involved cannot save the lives of people who are already dead when they reach the scene, or who suffer from irreversible conditions. The evidence from the Road Research Laboratory of the Ministry of Transport and from a report published in 1969 by Dr. G. N. Mackay seems to show that in nearly half the road fatalities of persons aged 16 or more dying within 12 hours, death occurs within 5 minutes, and just over half the deaths occur in 10 minutes. In rural areas the average time taken for an ambulance to get to the scene is 10–20 minutes. The Road Research Laboratory has estimated that, if the interval between the alarm and the arrival of an ambulance were reduced from 10–20 minutes to 5–10 minutes, it might improve the chance of survival of about 3 per cent. of all cases dying within 12 hours. This means, inevitably, that the scope for anyone trained in modern resuscitation techniques—whether they are police, ambulance men or doctors—to reduce the death rate much below the present level is bound to be somewhat limited. Nevertheless, 3 per cent. of all fatalities is just over 200 lives a year in this country, and any measures that can reduce this figure, or reduce the likelihood of permanent injury, warrant our most earnest and serious consideration.

In our Department we are considering the whole question of accident after-care at present. In doing so we have to consider a number of factors—more especially the saving of life, the reduction of morbidity, and the optimum use of our resources. In the case of resources, we have, for example, to balance the use of scarce medical manpower against the possibility of reducing the amount of time that patients need spend in hospital.

I hope that the North Riding scheme will provide a valuable and significant contribution towards our ability to improve accident after-care. We are getting a good deal of information already; and I hope that it may be possible to devise means for measuring the results more precisely.

The shortcomings in the data at present are perhaps an inevitable result of a situation where it was felt that the need was first and foremost to begin to look after people rather than to wait until the procedures for recording and analysing the results were fully organised, and it is not my intention to suggest that this is any discredit to sponsors of the North Riding scheme.

Indeed, the organisers of the scheme appreciated the need to produce demonstrable results and went to a great deal of trouble to devise special forms for use in evaluating the arrangements and to discover how far prompt attention on the spot did help towards the survival and health of those injured in accidents. My Department hoped to use the results, and instituted an examination of the scheme as a whole, with a special look at the records of those hospitals in the area covered by the scheme to which road casualties had been taken for treatment. The period examined was the year from 1st April, 1968, to 31st March, 1969.

This searching analysis was undertaken by a general practitioner who is currently a member of a university research department. Unfortunately, however, it turned out that there had been some misunderstandings between the hospital staff and the others connected with the scheme, with the result that the special forms were either not used at all or often not properly completed. Records entered up by the other services involved were found to be inadequate in certain respects. The unfortunate result was that the admirable intentions of the organisers as regards recording the outcome of the cases dealt with were largely frustrated. This made for some difficulties in seeking the hard facts. However, despite this handicap, some sort of picture of the year's activities was built up from the records of all the services involved.

Naturally, in piecing together information in this way there was scope for error, but it is believed that the following main findings are substantially cor rect. During the period there were 269 road accidents involving 388 victims, who were attended by one or more of the services in the scheme. Twenty people died at the scene of the accident. This involved a total of 17 accidents; the police attended all of these accidents; the ambulance service 13, the fire brigade 3, and general practitioners 11. There were no deaths in transit to hospital. Four victims died in hospital. Sixteen of the 20 victims who died at the scene of the accident were dead on the arrival of the general practitioner.

Two hundred and seventy-six road accident victims were taken to hospital. One hundred and two were treated in hospital but not detained. One hundred and seventy others were detained in hospital, but 118 of these stayed for one week or less. Twenty-eight general practitioners were involved in attending 155 road casualties during the year. One of them attended at 28 accidents, and six doctors attended between 5 and 10 accidents. Most of the remaining 21 doctors attended one or two accidents. Well over half the total number of accident cases was handled by ambulance personnel without the assistance of an attending general practitioner.

We have tried to draw some tentative conclusions from this analysis. I agree that it is remarkable that compared with a national figure of 25 per cent. of all road deaths in 1966 occurring in transit to hospital, none of the 24 North Riding fatalities in the period analysed died on the way to hospital; but the figures are too small to be absolutely statistically significant. I also agree that there were only four deaths in hospital of patients treated under the scheme.

However the picture is, as I said, not complete, and it is perhaps partly because of this that there are less encouraging aspects to the picture. For example, the ratio of deaths before and after reaching hospital—that is, 84 per cent. to 16 per cent. of the 24 deaths—is disappointingly similar to the results of an analysis of all road traffic accident deaths in the United Kingdom for the months of December, 1966, and December, 1967, when 82 per cent. of all deaths in persons aged 16 years or more dying within 12 hours of the accident died within 100 minutes of it.

For this reason, it is, as I said in reply to the hon. Member's Question on 13th April, impossible to analyse exactly the effect of the North Riding scheme on mortality or length of stay in hospital. Because the evidence is imperfect, I think that it would be wrong to take the data from this scheme as grounds for general advice on accident after-care, especially as this would anticipate a wide-ranging study of the subject which my Department has in hand at present. This study will naturally take account of the evidence from the North Riding scheme, and consider comparable schemes on the Continent as well.

At the present time a consulting casualty surgeon from Leeds in the N.H.S. and one of my medical officers are visiting six European countries to study their accident and resuscitation services. These countries are Holland, Sweden, Denmark, Germany, Austria and France. Their study includes the training of medical and para-medical personnel and the lay public in modern first aid, including the support of vital functions by clearance and maintenance of the airway, prevention of respiratory circultory failures, and arrest of haemorrhage; ambulance design and equipment; the autobahn accident care unit at Heidelberg; the use of electronic monitoring techniques at sites of accidents; direct links back to chief clinicians in hospital; and the organisation of casualty service in hospital. I shall be considering their report, as soon as it is available, in conjunction with the information on the North Yorkshire scheme.

I will, of course, study with great interest any further evidence the hon. Member or the organisers care to send me, and if in the course of this examination it seems necessary and feasible to have further statistical or other information on the North Yorkshire scheme or on any of the arrangements in other countries, we shall consider with those concerned how best to obtain this. I cannot, of course, anticipate what our conclusions may be, but my right hon. Friend the Minister of Transport and I regard it as very important to take all reasonable steps to save life and prevent the permanent injury of those involved in road accidents.

Meanwhile, although it is doubtful whether the interval between notification of an accident and the arrival of one of the after-care services at the scene could be significantly reduced, it seems that the police are usually the first to arrive on the scene and that with proper training they can play an important part in the emergency treatment of accident victims. It is also important that ambulance staff should be properly trained to give life-saving first aid to the seriously injured. Action has already been taken, and will continue, to improve their training, particularly the provision at nine ambulance training schools of two- and six-week courses on lines suggested by the Report of the Working Party on Ambulance Training and Equipment. Eight thousand ambulance men have now been trained on these courses. The training of ambulance staff is a matter kept under review by the Ambulance Service Advisory Committee set up by the Health Ministers.

I am grateful to the hon. Gentleman for raising this question. He has provided a useful opportunity to discuss what is being done, and I hope that my reply will have shown how we are deeply concerned with the problem of accident after-care. We are very conscious of what has been done and of the efforts of people in the hon. Gentleman's constituency. We in the Department, being concerned with the problem of accident after-care, are taking positive steps towards dealing with it.

Question put and agreed to.

Adjourned accordingly at seventeen minutes to Eleven o'clock.