Ambulance Services (North-East England) (Hansard, 18 January 1985)

§ Mr. Roland Boyes (Houghton and Washington)

I am glad to have been successful in the ballot for an Adjournment debate and to be able to raise the matter of public disquiet at the plans of the northern regional health authority, which I shall refer to as the health authority, for the reorganisation of the Northumberland ambulance services, which I shall refer to as ambulance services.

My hon. Friend the Member for Sunderland, North (Mr. Clay) first raised the problem in an Adjournment debate on 3 November 1983. Regrettably, today he and my hon. Friend the Member for Jarrow (Mr. Dixon) have important constituency business in the north-east and cannot attend the debate. My hon. Friend the Member for Sunderland, North painted a gloomy picture when he described in detail the reorganisation plans of the health authority for the ambulance services. He also described many serious incidents, in which patients using the ambulance services experienced massive problems. Because he described the reorganisation plans so adequately, I need only give a short summary, sufficient to put my comments into context.

The ambulance service is in the final stages of its reorganisation plan, in which a two-tier ambulance service is introduced. One tier is to deal with accidents and emergency cases, and the other with domestic patient transport. The plan, of which this is a part, is described in the document: "The case for a better ambulance service", which was sent to me by the health authority in December 1983.

The document made it clear that the number of ambulance men would be reduced to 467 from 577. That has been achieved because men who have not retired or taken redundancy pay are described as supernumerary; the number of vehicles was reduced by 95 to 161, which comprises 46 emergency ambulances and 115 standard sitting case vehicles; and because up to six ambulance stations were closed.

It is incredible and unacceptable that there should be only 46 ambulances for the whole of Northumberland and Tyne and Wear, which have a population of 1.5 million and a geographic area in excess of 2,000 square miles.

I wish to bring a specific closure to the Minister's attention. I am grateful to my hon. Friend the Member for Wallsend (Mr. Garrett) for telling me about the major problem at Prudhoe ambulance station. I have read carefully the case presented to the Minister for Health by Prudhoe town council. I understand the anxieties of the elected members and believe that they have a strong, just case that is supported by Tynedale district council and Northumberland county council to retain a full ambulance service at Prudhoe. I have seen a letter to the right hon. and learned Member for Hexham (Mr. Rippon) from the deputy mayor, Mrs. Garrett, and Councillor Mannion, which explains that the major changes were made at Prudhoe before the Minister had decided its future.

I have also been informed by the council that the present arrangements at Prudhoe lead to great difficulty. I could quote other examples, but the following illustrates 707 what can happen. On Sunday 13 January 1985, an ambulance was called to deal with a young man following a house fire in Prudhoe. However, between midnight and 8 am, there is no ambulance cover at the station. A policeman took the boy to hospital in Newcastle, which is 12 miles away, and had returned to the scene of the accident before an ambulance arrived. There is a clear need for a 24-hour fully manned service; otherwise there could be fatalities.

The Minister might be wondering why I asked for another debate on the subject so soon after the previous one. The answer is simple. It reflects the continuing concern of Labour Members in the northern group who represent constituencies covered by the ambulance service. Sunderland borough council, the National Union of Public Employees and ambulance men are just some of the interest groups involved. All those organisations and many other groups and individuals, especially patients, have expressed opinions since the previous debate. I shall cite only cases that have occurred since the previous debate to justify my decision to ask for an Adjournment debate on this matter.

During 1984, the northern group of Members has had many meetings with officers and elected representatives of the health authority in London and Newcastle. Members left none of those meetings with their fears for the future of the ambulance service allayed. My experience is that the anger of my hon. Friends is increasing. The northern group secretary wrote to the health authority in December 1984 asking for a further meeting, and the reorganisation of the ambulance service will be a major topic on the agenda. During our many meetings the health authority has been unable to produce convincing arguments or evidence that the plans would work, or that the prople whom we represent were unjustified in fearing the worst. On several occasions during the past 12 months, I have requested details of the criteria to be used by the ambulance service to monitor the new system, but to date I have received nothing.

A report produced by Sunderland borough council illustrates the anxieties of the people in the borough. Under the headlines in the Sunderland Echo in January 1984, Ambulance shake-up under fire", and, Sunderland Council slams ambulance service reshuffle", it is reported that a "grim prospect" report has been prepared. The report states: The plan for a two-tier system would produce a particularly severe risk of lack of emergency cover in the Washington, Houghton and Hetton areas. In Washington, for example, the level of service proposed to be provided in relation to vehicles and personnel will be similar to that provided in 1965, when Washington was still considered a village and its population was about 19,000. With the development of the new town, the population has increased to more than 50,000. Although it was not my motivation for introducing the debate—I am concerned for all areas where there are ambulance services—the Minister should be aware that I have just described my constituency.

The report also mentions something that I can confirm from conversations with ambulance men, exclusively outside their working hours. Morale is low and falling. The Sunderland Echo report mentions "bitter reaction" from "ambulance men", and states that "staff moral would 708 plummet". This week I was told that to say that morale is low is an understatement. It has never been lower. I was told that I could not exaggerate how bad morale is at present. Recently I talked to two drivers who were so fed up with the service they had to give to patients that they gave up and left the ambulance service. I cannot overstress the importance of changing the situation. I am told that matters have deteriorated continuously since the announcement of the restructuring. I talked to a number of ambulance men before Christmas, and it was made clear to me that the introduction of the domestic vehicle had had an accelerating downward effect on the morale of many of the men. They felt that, after years of loyal service, they had been downgraded.

The situation was not improved when, in March 1984, the health authority threatened to discipline ambulance men found to have spoken to the press. In March 1984 the Newcastle Journal said that this was because the men had mounted a large scale publicity campaign to win support from the public for their opposition to the plans Steve King, the divisional officer of the National Union of Public Employees, said that it was a disgusting insult to his members to try to gag those who opposed the plans.

I am also aware of public concern. In different ways, people make their concern plain to me. A constituent of mine organised a petition against the new plans and collected 12,000 names. A number of other petitions have been organised in the area and in March 1984 it was reported that six petitions had attracted 44,000 signatures.

The health authority invited comments on its proposals from interested parties. There were more than 60 responses, and the vast majority were highly critical.

My hon. Friend the Member for Sunderland, North has alleged that the reorganisation plans were a cash-saving exercise. In its report "The case for a better ambulance service", the Northumbria ambulance service states that "although almost incidental" savings are estimated at £1.6 million a year. I am sure that the Minister will be as puzzled as I am by the phrase "although almost incidental". I could dwell at length on its absurdity and illogicality. Like all health authorities, the authority has to save money to satisfy the policies of the Government. We would have understood the reorganisation programme better, although we would still not have agreed with it, if the health authority had openly and honestly told hon. Members and other interested parties that the new plan was a cost cutting exercise, that certain savings levels had to be achieved, and that the ambulance officer was planning a new system of operations to comply with his new budget targets.

Mr. Steve King was quoted in the Newcastle Evening Chronicle in December 1983 as saying: It is an endeavour to whitewash the threat to patients which will result from the authority's desperate attempt to save money at the expense of the community as a whole. We have now experienced the new two-tier ambulance system. I must make it clear that the system was introduced without the agreement of the work force. An official dispute is still in progress and the shifts are being worked under protest.

The emergency ambulances are still of the conventional design. However, the domestic vehicles are unrecognisable as ambulances. They have lost the red stripe, the blue light and the name plates. Most important of all, radios were not fitted initially to the ambulances. The domestic vehicles had no means of contacting headquarters. One 709 ambulance driver told me what he had been told to do if he came across an accident while driving one of the domestic vehicles. He was to stop, wave down a passing car, ask the occupants to ring for an ambulance, and wait with the injured party until an ambulance arrived.

Following the reaction from the men, it has now been decided to equip some vehicles with radios. I understand that some spare radios were available. The men are still not allowed to drive along with the radio switched on. The driver may switch on the radio only if he encounters an accident and needs to contact his base.

The Minister must already be asking himself what would happen if a serious accident occurred very close to a domestic vehicle but just off the road on which it was travelling. Clearly the answer is, nothing. The driver cannot be contacted by the base because his radio is continually switched off. This is absurd and ridiculous.

I had a letter earlier in the week from a person living in Newcastle who poses the question of what would happen in the case of a major disaster. Clearly, vehicles with experienced and skilled ambulance men would not be reached, and according to this correspondent, the health authority is not interested in discussing this situation.

My constituency is served from two ambulance stations, one in Washington and one in Herrington. With the assistance of the health authority, I have seen a number of response times to ambulance call outs. I am greatly concerned that the two stations are consistently outside the ORCON standard times. The implication of this is clear and simple. My constituents are in serious danger when they require an ambulance urgently. In one nine-week period which is representative of all the weeks that I analysed, the Washington and Herrington stations reached the ORCON standard response times on only four occasions out of a possible 36.

In the document "The case for a better ambulance service", the health authority wrote that taxis, hire transport and hospital car services are commercially engaged to carry 47,720 patients a year. If reorganisation proposals are accepted, this work could be done by the experts—the ambulance men. However, I have been informed that many taxis are still being used, sometimes as many as 60 to 100 a day. Recently, a patient had to use a taxi and required two drivers because of the nature of his illness. Taxies are often used to make long, expensive journeys. This would suggest that staff in the service and the number of ambulances should be increased, not decreased. I hope that the Minister realises that there is genuine concern in the north-east about what is happening.

I have a series of questions for the Minister, all related to the matters that I have raised. Is he as concerned as I am about the way in which the ambulances in my constituency have consistently failed to achieve the Orcon standards? The new arrangements will save £1.6 million a year, according to the health authority. Should not this figure be reduced, and more emergency and accident ambulances employed if there are risks to life? Does the Minister agree that all ambulances and domestic passenger vehicles should be fitted with radios and that those radios should be switched on at all times to avoid domestic passenger vehicles passing by close to a serious accident? Is the decision to introduce a vehicle that does not resemble an ambulance a step towards the privatisation of that part of the service?

Is the Minister concerned about the low morale of many in the service, because, along with doctors and the fire and 710 hospital services, the ambulance service is a life-saving service? Although I have not seen it myself, the press inform me that the ambulance service claims in its latest report an increased patient ridership of about 5 per cent. However, will the Minister check on how often patients are late in arriving at hospital and how long they have to wait to be returned to their homes?

The ambulance authority will not inform Members of Parliament what criteria it will use to decide whether or not the new arrangement is successful. Except for the cash saving aspect, will the Minister issue new guidelines on this matter? Will he let me know what is happening about the Prudhoe ambulance station, because the local community is anxious to retain a level greater than one emergency ambulance between 8 am and midnight, and will he investigate the incident that I mentioned? Will the Minister investigate whether there is an excessive use of taxis by the authority, sometimes in inappropriate circumstances, which is being used regardless of age, or fitness of the patient?

Is the Minister satisfied that 46 ambulances are sufficient to cover the people in the vast geographical area that I have described? Is the Northumbria ambulance service being used as a test bed for schemes to be introduced into other areas. My hon. Friend the Member for Newham, South (Mr. Spearing) told me this morning that similar proposals are being considered for the London ambulance service. Will the Minister visit the north-east to carry out a full inquiry into what is happening? Only in that way will my hon. Friends and I, the ambulance staff and users find some satisfaction.

§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)

I am obliged to the hon. Member for Houghton and Washington (Mr. Boyes) for the constructive way in which he made his remarks, for the interesting criticisms that he has made and the way in which he has represented the views put to him, including those of ambulance drivers who have given up their employment and of town councillors.

I am sure that the hon. Gentleman is aware that in the 10 or 11 minutes left I cannot do justice to the considerable selection of questions that he rightly posed on behalf of his constituents, his hon. Friends and those who work for the service but I undertake as soon as possible—and that means as soon as possible—to reply to his points in as much detail as I can.

The bounce and vigour with which the hon. Gentleman made his speech does him credit because I understand that at 3.40 this morning he was giving as good as he was getting in the Local Government Bill Committee.

Although I have said that I shall not attempt to answer all the hon. Gentleman's questions, I should like to have a preliminary skirmish with a couple of them to show him perhaps the flavour of the replies that he is likely to receive. I should like to pick one question — the response time of ambulances called out to emergencies and how quickly patients' needs are met.

I listened carefully to what the hon. Gentleman said about ambulance stations. I appreciate that he was not speaking solely on his own behalf but on behalf of his three hon. Friends, who are equally interested. The two ambulance stations most central to his constituency are New Herrington and Washington. The figures that the 711 hon. Gentleman gave to add credence to the fact that standards might not be as high as they should have been are completely different from the figures that I have.

I have the figures for December 1983 and December 1984 showing the percentage of calls responded to within 14 minutes. The hon. Gentleman will agree that that is the accepted standard. At the New Herrington station in December 1983 it was 83 per cent. and by December 1984 it was 95 per cent. At the Washington station it was 83 per cent. in 1983 and 90 per cent. by December 1984. That reflects on the excellence of the authority's new plan and the way in which it is working, and the staff's wholehearted commitment to make the plans work better.

The number of people employed, how many ambulances and ambulance stations there are, do not matter. They are of interest and people have vested interests in them, which rightly need protecting. The only thing that we should be interested in is getting patients from A to B. It does not matter whether 46 ambulances are right or wrong. What matters is that patients are carried from A to B as quickly as possible in times of emergency and that call-out standards continue to improve. If there is a particular case which the hon. Gentleman wishes to draw to my attention in detail, I shall study it in detail. The figures that are available to me today show that there are considerable improvements in the standard of service to patients. In saying that, I do not deny that the local community and the people who work in the ambulance service have a proper interest. Of course they have.

That enables me to answer at least in part one of the other questions raised by the hon. Gentleman — the potential closure of the main Prudhoe ambulance station. That is under careful consideration by my right hon. and learned Friend the Minister for Health and myself, and on his and my own behalf I take this opportunity to congratulate the town council on its excellent submission, which was logical, rational and coherent. I should be grateful if the hon. Gentleman would tell the council that. We are thus able to make our decisions on the evidence available from our own advisers and on that provided by those who represent the local community.

The overall plan against which the hon. Gentleman's comments must be set is based on the regional health authority's plan to subdivide the ambulance service into three parts — support services, communications and operations. At the same time, the health authority considered very carefully the number of staff and vehicles needed for emergency and non-emergency work. There is, of course, considerable debate as to whether the entire ambulance service should be regarded as an emergency service, but there is not time to go into that today. The regional health authority is satisfied that improvements 712 will not only be possible but have already been possible, despite a 28 per cent. reduction in the total number of vehicles and a 14 per cent. reduction in staff.

I have already given figures showing that call-out times have improved during this period of change in a service primarily concerned with individual people's lives and welfare. Almost as important as the improvement in that aspect is that more than £1 million per year is being saved to be spent on patients in need in other parts of the local health service. More patients are being dealt with in quicker call-out times. Yet a formidable ongoing saving has also been achieved. The ambulance service itself has also been divided into two sections, both of great importance — the emergency sector and the non-emergency sector.

I wish to reassure the hon. Gentleman and his constituents that the standards to which they have been accustomed will not be reduced. As I hinted in relation to the two stations that I mentioned, early results show a marked improvement in the emergency service. It would be pointless for me to deny that there were problems in the non-emergency service during the first few weeks but I understand that they are rapidly being rectified. Certainly, I know of no problems with the emergency service.

Call-out standards have shown a formidable improvement because the regional health authority has set high standards. Nationally agreed standards for the speed of response of all services state that 95 per cent. of all emergency calls should result in an ambulance at the scene of the accident within 14 minutes in metropolitan areas and 20 minutes in county areas. The regional health authority, however, has taken the view that people in rural areas are entitled to the same standard of service as their metropolitan counterparts in great cities such as Newcastle and has decided to apply the higher metropolitan standard to all areas. That in itself is a token of the determination of the health authority and ambulance authority to ensure not just greater efficiency and savings but a positive improvement in service to the patients, whom the people who work so hard in the ambulance service strive to serve.

I should say at this point that I greatly admire the way in which those who work in the ambulance service have responded so rapidly in the current very severe weather conditions. I am sure that the whole House will agree that the way in which all the emergency services have responded is an object lesson in high professional and service standards.

In conclusion, there is some area of disagreement between us on the policy. I hope that experience will show that it can be bridged. I am concerned about the detailed cases to which the hon. Gentleman has referred and I wish to answer as accurately as I can the questions set out at the end of his speech. I shall try to respond on both points as quickly as possible.