§ Motion made and Question proposed, That this House do now adjourn.—[Mr. Garel-Jones.]
§ 10 pm
§ Mr. Bob Clay (Sunderland, North)I am grateful for this opportunity to bring to the attention of the House an urgent matter of life and death. It is, of course, only one example of the piece by piece destruction of the National Health Service that is taking place up and down the country. It is one story from one area, but it must be one of the most shocking.
For several months there have been mounting complaints about the provision of ambulance services in the Sunderland area and adjacent districts of the Northumbria ambulance service. Sunderland community health council has expressed concern after a growing number of complaints from users of the service. The deputy leader of Sunderland borough council has described the present system as dicing with lives. Ambulance drivers and ambulance officers are in a state of agitation and distress such as I have not seen before amongst workers in the public service.
My hon. Friends the Members for Jarrow (Mr. Dixon) and for Houghton and Washington (Mr. Boyes), who cannot be here because of constituency commitments, and I have written to the Minister, to the chief ambulance officer, Mr. Caple, and to the regional health authority administrator, Mr. Hague. We have met with Mr. Caple and Mr. Hague.
Our concern is about the present and the future. The service has been inadequate for some months because the necessary ambulance cover is not provided on many occasions. If normal emergency cover at an ambulance station at a certain time is two crews and one crew is sick or on holiday, it has become the practice increasingly not to cover that by overtime. Alternatively, it has been the practice to use for emergencies an ambulance which is doing routine out-patient collection. Consequently, old, disabled, and sick people are being dumped halfway through a journey or are being stranded at hospitals. In other cases, the ambulance simply fails to turn up in the morning or arrives many hours late because it has been diverted to an emergency. The patients wait at home, not knowing what has happened. The staff are so overworked that it is not even possible for them to inform patients that the ambulance will not collect them that day.
This practice is also leading to the use of ambulances from well outside the area so the crews are not familiar with the district. Mr. Caple thinks that this is a sensible saving. We believe that it is potentially tantamount to murder because it leads to crews coming greater distances to emergencies in an area where they are unfamiliar with the geography and the names.
I should like briefly to give three examples. The first in my constituency is an illustration of how near the brink we have come. At nine o'clock one evening all three ambulances available at Sunderland ambulance station were at a fatal road accident in the Seaburn area of Sunderland. An urgent admission arose in the south of the area, also in Sunderland, and the only ambulance which was available in Washington had to be fetched, leaving the whole of Washington without emergency cover. At the same time the ambulance at Herrington, the only other ambulance anywhere in Sunderland, was called to another 1088 emergency. If there had been any further emergency anywhere in the Sunderland area it would have had to wait, however desperate and urgent it was. My hon. Friend the Member for Jarrow has had lengthy correspondence about a fatal accident outside the Rex cinema in Hebburn. It took place one quarter of a mile away from the Hebburn ambulance station and yet it took 25 minutes for an ambulance to arrive. The victim died the following day. When my hon. Friend the Member for Jarrow complained, he was given incorrect information. That has now been admitted and it has been established that it took 25 minutes for the ambulance to arrive. It emerged that the ambulance came from an area to which it should not have been sent because of the lack of ambulance provision there. The problem is complicated and nonsensical.
There was recently a case of a man driving an ambulance alone on routine outpatient work. He was asked to pick up someone whom he thought was a routine case. The patient started to behave hysterically and violently in the back of the ambulance while other patients were in it. The ambulance driver was not able to control the patient alone and had to call for assistance. It took a long time for that assistance to arrive as no other ambulances were available. It was discoverd later, and then only by fluke, that the patient should have been picked up by taxi and had been hysterical and violent for five days. The practice of sending taxis rather than ambulances is increasing. That is scandalous.
Some people believe that they are sane and that the rest of the world is mad. The senior officials who are responsible for the problems of the ambulance service in the Sunderland area seem to be such people. Rather than reconsider their policy and restore overtime coverage to ensure that all rotas are always staffed for emergencies, they have decided to make existing chaos and danger worse by permanently reducing the staff coverage. We have 586 ambulance men in the service. It is proposed to reduce their number by 110 to 476. Seventeen officers are to go and 95 vehicles are to disappear. Of the remaining vehicles, 75 per cent. will have no radios or emergency equipment. That is an insane obscenity when the service is already as bad as I have described.
Similar reductions are to be made among ambulance controllers. It is now being arranged that unqualified staff should sometimes operate the controls. There is also to be a dilution of staffing and a reduction of training. Those proposals are subject to consultation at the moment. The usual channels of writing letters and holding meetings have proved fruitless. It is as if we are playing with words and that provided that Mr. Caple can find a statistical manipulation or someone else to blame for each complaint all is well.
There are any amount of examples of dangerous circumstances arising from the poor ambulance service. The House will understand that, when patients die, relatives' wishes for no publicity must be respected. However, there are now two cases when it has been suggested that loss of life was caused by a failure of the service.
It is wicked to expose ambulance men to the possibility of public blame for failures which are not their fault. When complaints about a failure of the service have been made, the management reply that the slowness of the ambulance's arrival was the responsibility of the crew and that disciplinary action has been taken against them. It then appears that no disciplinary action is taken. It is 1089 utterly irresponsible for the management to write such letters. Either late arrival is the fault of the crew—in which case disciplinary action should be taken — or management is perpetrating a blatantly dishonest slander against the crew to cover up for the fact that the crew are worked off their feet and cannot do better. It is all most distressing for the ambulance men.
Examination of the facts and arguments about what is happening can be lost in the technicalities. I fear that that is what some of those who are responsible aim for. It is a sinister and profoundly disturbing side-issue in this matter that lay trade union officers representing ambulance men have been issued with threats of disciplinary action if they complain publicly about what is being done to the service. That smacks of the police state arriving.
I conclude by describing precisely what is proposed as an adequate emergency ambulance service at two crucial times of the day in my area. From midnight to 8 am— eight hours when factories, shipyards and service workers are working night shifts, people are coming home from clubs, and many people are going to work early in the morning — the entire coverage is provided by two ambulances from Sunderland ambulance station, one from Herrington, one from Washington, one from Hebburn, one from Jarrow and one from South Shields. For hon. Members not familiar with the geography of the area, the simplest way to explain it is to tell the House that seven ambulances will provide the entire coverage for the population of five parliamentary constituencies.
From 6 pm until midnight, which is an even busier period, there will be only one extra emergency ambulance in the Sunderland area, which will be stationed at Sunderland. There will then be eight ambulances to cover the population of five parliamentary constituencies. The figures are explained by using statistics and averages. We were told that the average number of call-outs measured during a period were only two an hour, so that we need only two ambulances; but an average of two can mean between zero and eight call-outs in an hour. It will be hard luck even if only three ambulances are required when the new arrangements begin.
The position is that of the sorcerer's apprentice. It is a combination of manic bureaucrats running riot in a scenario of an obsession with cuts created by the Government. The Minister has the opportunity now to step in and to halt the madness. If he does not, when the inevitable, unnecessary loss of life occurs, there will be no doubt about where the final responsibility lies.
§ The Under-Secretary of State for Health and Social Security (Mr. John Patten)The hon. Member for Sunderland, North (Mr. Clay) said that I have an opportunity. I certainly have an opportunity to thank him for raising the matter and to say that his speech was forceful. I am sure that his constituents, if they read the record, will realise how forceful it was. I also have the opportunity to invite him to write to me personally about any of the cases that have caused him disturbance. Without prior information, I cannot reply to the matters that he raised tonight. I also have the opportunity to tell the hon. Gentleman that the use of words such as "murder" and 1090 "obscene", and allegations about the existence of a police state in Northumberland, of all places, has not helped him to make his case.
I shall make my case by addressing the hon. Gentleman's attention to some general principles and then considering the facts as we see them. Ambulance men who provide a dedicated service in the NHS do great service to the country, but that service should always be examined critically not only to see what it provides but to see how it can be provided more effectively. I was pleased to learn that the Northern regional health authority had undertaken a review of the Northumbria ambulance service. Final decisions on many aspects of the new service have yet to be settled, but it is encouraging to me and my colleagues in the Elephant and Castle to see a health authority tackling its reviews sensibly. I hope that all health authorities are srutinising their activities not simply to see what they provide but to see how they can provide their services more efficiently, putting people and patients first. The NHS exists primarily for patients, not for its employees or for trade unionists. Nor does it exist for Ministers who make speeches about the service.
The hon. Gentleman is aware of the background to the present plans which the regional health authority has produced for the Northumbria ambulance service, but I do not think he has clearly understood the fact that the authority has a twofold aim. First, it wishes to improve the service to patients and, secondly, it wishes to provide a more cost-effective service. The two aims go hand in hand. The more efficient the service, the better it is for the patient.
The scheme will provide three divisions and two tiers. The RHA's proposals would sub-divide the service into three divisions, each headed by a divisional officer. The three divisions would relate to support services, communications and operations. At the same time, there would be a rationalisation of ambulance stations, with a concentration of the ambulance services in south-east Northumberland at Ashington and Seaton Delaval and those to the west of Newcastle at Blaydon. Hexham and Throckley. The new proposals are expected to save, in a full year, the considerable sum of £1.6 million. The money will stay within the NHS to be used for better patient care within our record overall expenditure on the NHS.
It ill behoves the hon. Gentleman to suggest that this rationalisation is the result of cuts. It is the result of a long and detailed examination of the ambulance service in Northumbria which has been carried out over a number of years with the aim of providing a better service. The proposals are not all concerned with saving money. The NHS will certainly benefit from the more streamlined service, but, at the same time, ambulance staff in the area will benefit from a greatly improved productivity bonus scheme.
It is proposed that in most of Northumbria there will be a two-tier ambulance service separating the control of the emergency service from that of the non-emergency service. It is a most interesting scheme, and will be very effective. Tiering or separating the two elements of the service for day-to-day operation has always caused some controversy, but it is becoming commonplace in many of the larger services in this country. Its critics rarely claim, as the hon. Gentleman has claimed, that it will adversely affect the emergency service. They suggest that the routine work will suffer from either an increase in costs or a reduction in service provided.
§ Mr. ClayI chose to speak tonight about the emergency services, but I have given a number of examples of ways in which routine services were being adversely affected. People in the area are concerned as much about the routine services as about the emergency services. I have referred to cases of outpatients waiting for an ambulance all day and not being told that that ambulance had been sent elsewhere.
§ Mr. PattenI have already offered to investigate any cases which the hon. Gentleman may refer to.
One of the advantages of the two-tier system is that all ambulance crews can be more effectively and specifically trained for their tasks. There will be much less risk of the service being unable to respond satisfactorily to a real emergency. What makes the Northumbria proposal especially welcome is that it is intended to reap the advantages and yet reduce the resources needed by making considerable savings on operational costs.
I can reassure the hon. Gentleman and his constituents that standards must be, and will be, maintained. The essential standard against which to measure the performance of any ambulance service in responding to an emergency call — and the hon. Gentleman, no doubt quite rightly, highlighted the emergency service—is the time that it takes for an ambulance to reach the scene. Indeed, the hon. Gentleman mentioned that several times. Of course, it is equally essential to have well-trained crews using well-equipped and up-to-date ambulances.
The appropriate treatment of the patient at the scene of the accident, or in the ambulance on the way to hospital, is also vital in those critical moments, and so speed is of the essence. There are nationally agreed standards for the speed of response that should be attained by all services. Of course, they are tighter for metropolitan services than for county services. It is worth mentioning the standards and criteria that are set. In metropolitan services, it is expected that 95 per cent. of all calls should be responded to within 14 minutes. This information is important for the hon. Gentleman, because it will enable him to balance his complaints against the expected standards. The county standard requires 95 per cent. of calls to be answered within 20 minutes. The Northumbria ambulance service would continue to meet the standard required in metropolitan Sunderland. In addition, the regional health authority believes that all those served by it, including those in the outlying parts of Northumbria, are entitled to the same standard of service.
§ Mr. PattenI shall certainly give way again, although it prevents me from answering fully all the hon. Gentleman's points.
§ Mr. ClayI am familiar with the guidelines and I know that 95 per cent. of calls should be answered within 14 minutes. But if among the remaining 5 per cent. there is a case that involves a delay of 25 minutes resulting in loss of life—as ambulancemen allege happens in the area—it would appear not to matter whether or not the national regulations have been met, because the fact is that there is unnecessary loss of life. That is what concerns people.
§ Mr. PattenI am glad that the hon. Gentleman has refined his language and is now speaking of allegations rather than certainties with regard to loss of life in his area. I can only repeat my invitation to the hon. Gentleman to write to me and give me full details of the cases that involved those allegations. I shall have them looked into quickly and will reply to him as soon as possible.
It is important to realise that these plans have not been conceived in haste, or imposed on the ambulance service from outside. They are nothing whatever to do with any financial problems that the regional health authority may have now, or have had in the past. They are the result of long and careful study, and are the culmination of years of intensive review within the service, with the aim of providing a better ambulance service in the area.
It is worth pointing out several of the things that the hon. Gentleman ignored, such as the many savings that will come from the introduction of computer-assisted planning and scheduling of the more routine work, and the closing of unnecessary and inappropriately sited ambulance stations. The Northumbria ambulance service is quite confident that these changes, coupled with the very important productivity improvements that are linked to the bonus scheme for staff, will produce a more reliable non-emergency service and a more professional level of service overall.
Many critics of the Northumbria proposals judge them against the existing service. I think that that is a mistake. One has to stand back from the existing service. The regional health authority has done that, and has consdered the service objectively from the patients viewpoint, which is what a modern Health Service should do all the time. It has not said, "How can we use the existing staff and vehicles?", or started from there. Instead, it has assessed patients' needs, and has gone on to look at ways and means of meeting them. Critics have also spoken — I understand quite misleadingly — about the number of jobs that will be lost.
The critical question is not the number of jobs that may be lost; it is always the patients and the money available for them. A key question is why the regional health authority ambulance service has been going on for too long with more people and at a greater cost than it needs. The task of a modern health service is to refine the system in the patients' interest. I welcome the initiative taken by the regional health authority in setting up the review of the Northumbria ambulance service, and I am very much encouraged by its businesslike approach to this review.
The operation of the service is the direct responsibility of the regional health authority. I see no reason to intervene in that, but every reason for examining the disturbing cases and the allegations made by the hon. Gentleman. I should be grateful if he would let me know about them as soon as possible so that I can look into them.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-five minutes past Ten o'clock.