HC Deb 06 July 1977 vol 934 cc1383-94

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

9.56 p.m.

Mr. A. J. Beith (Berwick-upon-Tweed)

Having drawn the attention of the House to the problems of mobility of the disabled, I now seek to draw its attention to the problem of transport for seriously ill people and others who need ambulances. I am grateful for the opportunity to raise an issue that is causing great concern in my constituency, namely the proposal by the Northern Region Health Authority to close the ambulance stations in Alnwick and Belford and replace them with one station between the two towns.

Until the last Conservative Government centralised the National Health Service under the guiding hand of the right hon. Member for Leeds, North-East (Sir K. Joseph) it would neither have been permissible nor necessary to raise in the House the question of the location of an ambulance station. Until that time, ambulance services were controlled by elected local authorities whose councillors were directly responsible to the local community for their decisions. In our case it would have been the Northumberland County Council, on which Alnwick and Belford have their own representatives. Now, however, our ambulance services throughout the whole of the North of England are controlled by one vast, undemocratic body, the Northern Region Health Authority. Not a single member of that authority lives in the Alnwick area—or anywhere else in my constituency—and in any case it is responsible not to the local electorate but to the Minister for its work. It is not his fault that the buck now stops with him—he inherited this crazy system. However, it is a fact. I put it to my hon. Friend that he has a responsibility to see that the wishes of the local community are not flouted by a remote and bureaucratic regional Health authority.

The background to the situation is this: Alnwick, a town of 7,000 people, has a station with three ambulances manned by 11 men and a station officer. Also in Alnwick are the infirmary, a health centre and other clinics and surgeries. It is the centre for a relatively heavily populated area of my constituency, which also contains tow coal mines and several small factories.

Fifteen miles to the North is the village of Belford, which is the centre for a very large area of more scattered population. Two ambulances are stationed there. The proposal of the regional health authority is that both these stations should be closed and replaced by one 24-hour station in a very isolated situation off the Al road between the two places at North Charlton, some seven miles north of Alnwick and eight miles south of Belford. The population in the immediate vicinity is tiny, and the roads in the area are such that larger centres of population along the coast, such as Seahouses and Beadnell, would gain no significant advantage at all from the new siting, and it is much further away from the collieries and from other population centres than is Alnwick.

The proposal is misguided in the extreme, and has been greeted as such by responsible people in both communities. A group of Alnwick ambulancemen are quoted in the Northumberland Gazette as saying: The Alnwick station is at present in the urban centre where the population density is the highest and is in close proximity to schools, collieries and industrial sites, where accidents can and do happen. To move the ambulances away from the population seems to us to be criminal. The doctors of Alnwick issued a joint statement giving it as their view without reservation that there appears to be no logical justification for the adoption of such a proposal. We would therefore like to take this opportunity of wholeheartedly endorsing the views of the ambulancemen and to ensure them of our support against the implementation of the proposed scheme."—

It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.

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

Mr. Beith

Similar opposition has been expressed by the community health council, Alnwick District Council, Alnwick Town Council and the National Union of Mineworkers, and large numbers of the public have expressed their opposition by backing a campaign against the proposal run by the local paper, the Northumberland Gazette. The county councillar for Belford, Mrs. Stephenson, said We feel very strongly about this and no one seems to agree with the proposal. Indeed, it is very significant that no one, not even the regional health authority itself, has yet come up with a single positive argument in favour of the scheme. I shall come to the reason for its advancement in a moment. First, however, I would remind the House of its disadvantages. If the ambulances were stationed at North Charlton, they would be appreciably further from the centres of population, the hospitals and the high-risk installations they serve. From either Alnwick or Belford up to 15 minutes would be added to almost all journey times, which could be disastrous in an emergency. Delays could often be greater than that. The Al both north and south of North Charlton has steep banks which are badly affected in winter by snow and ice, and have been blocked for hours at a time in recent recollection, including last winter.

In summer, as we know now to our cost, it is impossible even for an ambulance to overtake queues of holiday traffic, caravans and heavy lorries on many stretches of the Al, which has only a single carriageway in each direction. These delays would also affect relief ambulance crews driving out to the station from their homes in Alnwick or Belford to replace the duty crews if they were called out on an emergency. It is, of course, neither intended nor really practicable to build houses at North Charlton so that all the crews can live there. The cost of the scheme—particularly if houses are ever to be added to it—will be enormous.

Why, then, has it been contemplated? The only reason so far advanced is that sites are no longer available for stations in Alnwick and Belford. It is true that the present ambulance station in Alnwick is owned by the district council and that the health authority has been asked to vacate it. It is also true that the old station at Belford was closed on the instructions of the Health and Safety Executive and that there is at present no covered accommodation for the ambulances at Belford. However, the district council has made it quite clear that there is no question of its forcing the ambulances to leave Alnwick. It is perfectly happy for them to stay until an alternative site can be found.

I think that the Minister was inadvertently misinformed when he gave a Written Answer to a Question recently, when I asked him about the proposal. The answer he gave was: I understand that it is one of a number of options being considered by the Northern Regional Health Authority due to premises at Belford and Alnwick being no longer available."—[Official Report, 28th June 1977; Vol. 934, c. 136.] I can understand that the Minister was advised to say that, but it is far from the case that premises could not be found. Although there have been difficulties with the present sites, I have no hesitation at all, knowing the area, in saying that a suitable site in Alnwick could be found. I know that both the council and local private landowners are very willing to co-operate in seeking a site in Alnwick. Indeed, I suspect that an ideal site could be made available. In Belford a local garage firm has offered a suitable bay in new premises which are being constructed, and other possibilities are also open.

The site problems in both places are easily surmountable and in no way justify the North Charlton scheme. Why, then, is it under consideration at all? I can only surmise that somewhere in the administration of the regional health authority we have a "rationaliser" at work, who has seized the opportunity presented by the site question to plant a cross on a map with the same reckless enthusiasm as that which ran through the rest of the Health Service reorganisation. I hope the Minister will make it clear that this kind of desk-top rationalisation is not his policy and that he shares none of his predecessors' enthusiasm for amalgamation for its own sake.

The regional health authority has climbed a few steps down within the last 10 days. Overwhelmed by the scale of local opposition, it has set up a special committee to consider the matter. Not one member of this committee comes from my constituency or anywhere near it—the nearest lives 25 miles south of Alnwick. However, if they approach the matter objectively I do not see that they can possibly support the new scheme.

The chairman of the health authority has accused those of us who have opposed the scheme, including the local newspaper, of jumping the gun, because, he says, no final decision has been taken. I am sure that the Minister's experience on this sort of thing is the same as mine— if one does not jump the gun, it tends to go off and kill the victim. It is then too late to suggest that it might have been better not to have pulled the trigger at all.

Things seem to have been much further advanced than the health authority is now admitting. In May its public relations officer told the Gazette that the decision to leave the existing Alnwick ambulance station site is final and irrevocable ". He also said You can only have one station. And we must cover both areas. He added that it was proposed to start work at North Charlton as soon as possible.

Indeed, the authority applied for planning permission in respect of the North Charlton site in May, and it was that approach which sparked off the controversy. It had been known for some time before that the authority was considering the North Charlton scheme—this was admitted in a letter to me from the regional administrator in November last year—but, as the Alnwick doctors put it in their statement, Our failure to respond earlier was born of the disbelief that such a proposal could ever have been taken seriously. It was the planning application which made everyone realise that the authority was perfectly serious about it, and protest became essential. Planning permission has not yet been given because the district council regards the North Charlton site as so unsuitable. I am very glad that the authority has retreated from its original position and indicated that it will seriously reconsider the whole question. I should like to believe that the outcome of such a reconsideration is a foregone conclusion, because the disadvantages of the North Charlton scheme are so obvious. However, large organisations do not always change their ideas very readily, so the case must be pressed even harder.

I hope, therefore, that the Minister, with whom ultimate responsibility lies, will indicate two things to the regional health authority—first, that it should pay a great deal of regard to local opinion, particularly the opinions of those involved in running and using the health service at local level, whose views I have tried to express tonight; secondly, that he does not favour schemes of rationalisation which do not offer either positive and demonstrable advantages to the users of the health service or substantial economies to the taxpayer. I see no sign of either in this scheme. I am grateful to the Under-Secretary for looking into this matter, and my constituents will be even more grateful if he ensures that the result is a sensible decision based on local knowledge.

10.7 p.m.

The Under-Secretary for Health and Social Security (Mr. Eric Deakins)

I am grateful to the hon. Member for Berwick-upon-Tweed (Mr. Beith) for raising this subject. Perhaps I can first paint the general picture. Following the reorganisation of the National Health Service in 1974, responsibility for the provision of ambulance services was transferred from local authorities to health authorities. As with other Health Service buildings, the responsibility for the closure or resiting of ambulance stations therefore rests with the health authority. There are so many variations in circumstances, resources and needs affecting the location of individual ambulance stations that I am sure the hon. Member will agree that this matter is best left to local decision after appropriate consultation and discussion with those most directly affected.

On the reorganisation, 124 services in England were regrouped into 45 services, and one of the problems was differing standards of service to the public. My Department therefore issued guidance to authorities in 1974 based on an independent study by the Cranfield Institute of Technology advising them of standard measures of service to patients for the ambulance service. My Department suggested standards of service for both emergency work, for example "999" calls, and non-emergency work—that is, the routine movement of patients to hospital. These standards set targets which all services should aim to realise.

Thus, when considering the closure or resiting of ambulance stations the health authority should take these standards of service into account. For emergency work the standard is the total time taken to respond to an emergency call once notification has been received. The time laid down between notification and arrival at the scene for an area health authority ambulance service is 20 minutes in 95 per cent of the calls and eight minutes in 50 per cent. of calls. There is a further requirement to activate the ambulance— that is, to deploy the vehicle to the incident—in three minutes, again in 95 per cent. of the calls. While these standards are not binding, it is desirable for the ambulance service to achieve them, and it generally does. I should hope that in selecting an alternative site for an existing ambulance station an authority will seek to improve the ability of its ambulances to respond promptly to all calls for assistance wherever they originate within its area.

In Northumberland, the Alnwick and Belford ambulance stations became the responsibility of the Northern Regional Health Authority, which administers the new Northumbria Ambulance Service. This includes services for the whole of the metropolitan county of Tyne and Wear as well as Northumberland. It would be helpful if I detailed these arrangements for Belford and Alnwick which were inherited at the time of NHS reorganisation from the Northumberland County Council.

At Belford the facilities consisted of a garage, two ambulances and a staff of three full-time and one part-time ambulancemen, providing eight hours' continuous cover with sixteen hours' standby, when an on-call service operates. The garage has recently been demolished at the order of the Health and Safety Executive because it was considered unfit for human occupation and was in any case not a purpose-built garage but a converted stable. At present the ambulances are being left outside the local social services home, although arrangements are in hand for private garaging.

At Alnwick there are 11 full-time staff with three ambulances to provide 16 hours' continuous cover with eight hours on standby. Alnwick District Council has, however, given the Northern Regional Health Authority formal notice to quit the existing premises with effect from 31st March because they are required for council use. Occupancy of the premises will be allowed to continue on a month-to-month basis, but it is not clear to the regional health authority, however, whether this facility will be afforded to it until such time as a new station can be provided.

It is within this context of the difficulty of continuing to provide services from both these stations that the officers of the Northern Regional Health Authority have been examining the possibility of combining the Belford and Alnwick staff and vehicles in a single station. This is what has led to the consideration of a single site at North Charlton which is situated approximately mid-way between Alnwick and Belford. One of the potential advantages of the combination of the Belford and Alnwick staff and vehicles would be the ability to provide a full 24-hour manning service which might offer a better station as well as costing less than replacing two separate stations.

I wish to stress, however, that this is merely one of the options that the Northern Regional Health Authority will be considering when it has more information about other sites which might be available. Once this information has been received, the Northern Regional Health Authority intends to prepare a consultative paper describing its proposals for replacing the services at Belford and Alnwick which circumstances outside its control have forced it to consider.

The consultation paper will be prepared in the light of all the information that the Northern Regional Health Authority is assembling concerning the population to be served in and around Belford, some 2,000 people—and Alnwick—some 21,000 people—the distance between them by road, some 15 miles, and the communication links between them and other districts served in mid- and north Northumberland. There are also, as I am sure the hon. Member will agree, particular problems in providing ambulance services to rural communities, especially those which, as in this case, are liable to be isolated in bad winter weather conditions or have a relatively larger influx of summer visitors, as the hon. Gentleman pointed out. There is also to be considered the question of the practicality of a relatively rural site such as North Charlton for an ambulance station. The hon. Gentleman drew attention to the difficulties there.

It is right to stress that the Northern Regional Health Authority is merely at the present lime looking into a number of options to solve the problems associated with the Belford and Alnwick ambulance stations. The proposal regarding the siting of an ambulance station at North Charlton became public because it was necessary for officers of the regional health authority to test the feasibility of the site as a possible option by making an outline planning application. Understandably, when this became known considerable concern was generated locally, leading to representations from local authorities, members of the public and local Press. Clearly it was of great concern to them that a decision might have been taken without adequate consultation.

However, let me assure the hon. Member, as well as the members of the public in whose interests he is raising this subject, that there will be full and proper consultation before any decisions are reached. The procedure to be followed by a health authority before it can close or change the use of an ambulance station is no different from the procedure which has to be gone through before a health authority can close or change the use of any other type of Health Service premises. The example that we all know from Adjournment debates in recent months is the closure of hospitals.

I assure hon. Members that health authorities do not make proposals or reach decisions on closures or change of use lightly. There are national and regional guidelines which serve as a framework within which to work. In following these guidelines they are expected to show much openness, consulting very widely.

The Northumbria Ambulance Service is administered by the Northern Regional Health Authority and, therefore, that authority will be responsible for the consultation process. As I have already said, the authority is at present examining the possibility of combining the Belford and Alnwick ambulance staff and vehicles at one single station. I am assured that as soon as this examination is complete a consultation document will be issued setting out the regional health authority's proposals.

I must emphasise that the document will be the subject of widespread local consultation with all interested bodies, including Members of this House with a constituency interest, local authorities and the community health council, whose important role, as the hon. Member will well know, is to represent the public interest in matters relating to health services. If the council wished to object to the proposals which are put forward by the regional health authority, it would have to put forward counter-proposals which paid full regard to the factors, including constraints on resources, which led the authority to make the original proposals. If such counter-proposals were to be made and were not acceptable to the regional health authority, it would fall to my right hon. Friend the Secretary of State to act as arbiter and make the final decision. As proposals have not yet been formulated, I do not wish to comment in any detail about the relevant merits of the sites which have been under discussion tonight, and nothing I say should be construed as prejudging the issue in any way.

The Government attach great importance to the aim of enabling decisions to be made, wherever possible, at local level. Studies have taken place over the last year of the scope for greater devolution of functions from the Department to regional health authorities, and from regions to areas. Much progress has been made in consideration of proposals for devolution from the Department to regions, and suggestions made for devolution to areas will be followed up with the RHAs over the coming months. Some have already been adopted. We shall be receiving further reports at the end of the summer.

Mr. Beith

While mentioning the need for consultation and the emphasis that his Department places on letting decisions be taken at local level, I hope that the Minister recognises the importance that regional authorities should attach to consultation when such authorities contain no members from anywhere near the affected site. I hope that the Minister will not delude himself that a decision of a regional authority so far from the affected area could be thought of as a locally-made decision.

Mr. Deakins

I accept that the hon. Gentleman is not satisfied with the degree of democracy, and I shall have a word to say about that later. Community health councils have local people on them, and if they are anything like my local council they will be vociferous and diligent in protecting the interests of the local community. Whatever one thinks of the reorganisation of the NHS, the emergence of community health councils has been widely welcomed on all sides.

The Government attach great importance to making health authorities, particularly regional and area authorities, as representative as possible. To this end we have stated that, as a general rule, one-third of the members of these authorities should be drawn from local government. It cannot, therefore, be regarded as completely undemocratic since there is a degree of indirect democracy. That may not satisfy the hon. Gentleman. It does not satisfy a lot of people, but we have improved the situation. We have also said that CHCs should be entitled to send at least one of their members to each meeting of their corresponding AHA. By this means we hope to include as many people as possible in the decision-making process.

I can assure the hon. Member that the Northern Regional Health Authority has not made any decision of any kind on this subject and will not do so without taking into account all the representations made to it following full consultation.

There is the long-stop that I have already mentioned—namely, that, if the CHC should react vociferously and put forward counter-proposals which are not agreed by the regional health authority, the matter will come, as with previous hospital closures, to my right hon. Friend the Secretary of State. It will fall to him, in the light of all the evidence and the representations, to make a final decision. We regard that very much as a matter of last resort. Surely it is better in a democracy that the emphasis should be very much on devolution from this House. Surely we should devolve as many as possible of these decisions, which concern local people, to local organisations.

I hope that it will be possible locally to reach a decision acceptable to the region, the area, the CHC and all the hon. Gentleman's constituents.

Question put and agreed to.

Adjourned accordingly at twenty-one minutes past Ten o'clock.