HC Deb 15 May 1986 vol 97 cc956-62

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

10.21 pm
Mr. John Hunt (Ravensbourne)

I am grateful to you, Mr. Speaker, for giving me this opportunity to draw attention to the recent very serious deterioration in Bromley's ambulance service. It is causing great distress and difficulty to many of my constituents. The story that I shall recount to the House is one of muddle and misjudgment by the London ambulance service, which apparently failed to foresee the consequences of its own recent decisions. I was first alerted to the potential problems at the beginning of this year, when a Bromley ambulance man, who is one of my constituents, warned me of the impact of the new rotas that had been agreed between management and the unions.

As a result, I wrote at once to the chairman of the South West Thames regional health authority, which, for reasons not immediately clear to me, administers the whole London ambulance service. At that time, my concern was primarily with emergency cover. In his reply, dated 6 February 1986, the chairman, Mr. Tony Driver, offered me considerable reassurance. He told me, for example, that for some months the authority had been looking into A more efficient use of vehicles which would be more responsive to the pattern of demands. The letter continued: There will in fact be an overall increase in emergency cover. Thus, I was reassured. But of course I had been told only half the story. It subsequently transpired that the cuts were being made not in emergency but non-emergency cover—the walking patients as they are sometimes called.

The cuts were in direct contradiction to specific assurances that had been given to my hon. Friend the Member for Chislehurst (Mr. Sims), who has also been actively engaged in these matters, but who is unfortunately overseas on parliamentary business tonight. My hon. Friend received a letter dated 25 February from the chief officer of the London ambulance service, in which he was told that special funding was being provided to meet the situation. As far as I am aware, no such funding has been made available.

It was about that time that I and other of my hon. Friends who represent constituencies in the borough of Bromley began to receive complaints from our constituents about the numerous cancellations and delays within the local ambulance service. I therefore wrote again to Mr. Driver on 22 April expressing some surprise that I had not been forewarned of the reductions, and telling him of their disastrous impact on my constituents.

At about the same time, the district general manager of Bromley health authority, Mr. P. A. Ward, wrote in similar terms to the regional general manager of the South-West Thames RHA. Mr. Ward expressed his serious concern at what he called "the sudden and unplanned" reduction in Bromley's ambulance service. His letter highlighted the draconian cuts that were being imposed.

Apparently, the original demand from the London ambulance service had been for an immediate reduction of 40 per cent. in non-emergency patients. That in itself' was bad enough, but by April the position had become immeasurably worse—a demand was made by the divisional ambulance officer for a reduction not of 40 per cent. but of 70 per cent. in the service for walking patients. That represents a reduction in coverage from 513 patients a week to 163. It was, therefore, hardly surprising that the many patients affected were up in arms and wrote, and are still writing, to me and other Members of Parliament.

I wish to quote one letter from a young lady living in Hayes in my constituency. She said I am writing to you about the ambulance cut backs. I am disabled and used to go to Guy's hospital in London by ambulance but I have been told that due to cut backs I cannot have transport any more. The hospital has tried to get me transport and so has my own doctor, but it has been to no avail, so I can't go to the hospital any more. I can't walk very far. I have arthritis in my legs and my hands. That young girl of 23 is clearly suffering greatly.

In Bromley, ambulance service support has been withdrawn from the Phoenix centre for physically and mentally handicapped children at Farnborough hospital. That centre does magnificent work in providing therapeutic treatment for more than 20 severely handicapped children from all parts of the borough. Surely their parents have enough to cope with without the additional strain of having to make individual travel arrangements for them every day.

Mr. Humfrey Malins (Croydon, North-West)

I am sure that my hon. Friend is aware of the immensely successful hospital in Croydon, the Mayday, and the fantastic work that it does. However, is he aware that many consultants at the hospital have approached myself and other hon. Members representing Croydon constituencies because they are concerned about the effectiveness of the London ambulance service? They are worried about the problems with the service in the Croydon area.

Mr. Hunt

I am grateful to my hon. Friend, because his intervention emphasises how widespread the problem is. I do not wish in any way to suggest that it is confined only to Bromley; I know that it goes very much wider than that.

Another example in Bromley is the Stepping Stones club, which provides facilities for patients who are recovering from mental and other illnesses. Only this morning I received a letter from the chairman of the Bromley Council for Voluntary Service, His Honour Judge David Griffiths, expressing his concern at the withdrawal of ambulance service support. Part of his letter reads: There appears to be severe cuts in ambulance service or community care and yet it appears to be Government policy to increase and encourage this very type of service. That emphasises a policy contradiction in what is happening.

I have seen a copy of a letter sent by a distinguished ophthalmic surgeon in Bromley to various health authorities and hospitals expressing his great concern at the effect of the cuts on his patients. A section of his letter reads: a high proportion of our patients are old and unable to use public transport, and unfortunately many of them have no relatives living locally and appear to have no neighbours who are able to help and hence rely entirely on the ambulance service to attend outpatients. The letter continues: As you will appreciate, these patients include those with long-term conditions, such as glaucoma, which need to be kept under review. There are also post-operative patient and it is essential we see these patients as required at the outpatient clinics. If they cannot attend I can foresee that inevitably there will be disasters with regard to their treatment which could lead to diminution or even loss of their vision which would not be rectifiable. That is what is happening in Bromley. It is inhuman and intolerable. Faced with this crisis. I am bound to say that I regard the response of the London ambulance service as both casual and complacent. I can only describe the most recent reply that I received from the chairman of the South West Thames regional health authority to my latest letter of protest as quite remarkable. I shall quote two sections of it. He wrote: The London Ambulance Service has been faced with an almost impossible task since March as the introduction of the new structure had to be subject to a free vote of all ambulancemen before we, as the managers, would know whether it should be introduced and, following from that. the extent to which ambulancemen would then be willing to undertake over-time if required, could not have been foreseen. Surely any competent and responsible ambulance authority would never have embarked upon a new structure of working until it had assessed the full impact of the new rotas upon the patients that it is there to serve. Mr. Driver's letter continues: When the introduction of the new salaried structure was decided, we and the LAS between us wrote both to Regional and District General Managers throughout London pointing out that in the short-term the imbalance between need and availability could only be matched if the number of patient journeys could be radically reduced. The impact of this on individual patients was a matter which was largely in the hands of the Health Authorities themselves, since they alone can restrict demand. It seems that that comment begs the question why it was necessary to restrict demand in the first place. I think that that was dodging the issue. A major miscalculation has been made and now Mr. Driver tells me that the London ambulance service is hoping to recruit more men, and perhaps women, to fill the gaps in the present provision.

I ask my hon. Friend the Minister three specific questions. First, when will the shortfall be made up? Secondly, is the recruitment of the additional ambulance men subject to any financial restraint or cash limit? Thirdly, when will the 70 per cent. cut in non-emergency provision in Bromley be restored?

I came into politics, as I am sure my hon. Friend did. to improve the lot of those whom I represented. Cuts in ambulance provision of this nature and magnitude, cruelly affecting the most vulnerable sections of the community, make a mockery of all that I have been seeking to do throughout my period in public life. I beg my hon. Friend to act, and to act quickly, to restore the qualities of care and compassion both to the London ambulance service and to our Government.

10.34 pm
The Parliamentary tinder-Secretary of State for Health and Social Security (Mr. Ray Whitney)

I am grateful to my hon. Friend the Member for Ravensbourne (Mr. Hunt) for the opportunity to respond to what is clearly an important matter. I was already well aware of the strength of his feeling on the subject, but he has reinforced my impression of his deep concern. I am grateful also for the opportunity to respond to the intervention of my hon. Friend the Member for Croydon, North-West (Mr. Malins). I accept, too, that he is disturbed about what has been happening to the ambulance service for his own constituents.

I must say, at the outset, that we recognise that there have been problems and indeed, in some cases, serious problems, and improvements must be made. I hope that I shall give my hon. Friends some reason for believing and hoping that those improvements are now in train. Certainly, positive things are happening.

I shall attempt, initially, to set the whole effort in context. These days, we hear far too much about expenditure cuts in the National Health Service. As my hon. Friends the Members for Croydon, North-West and for Ravensbourne recognise, the National Health Service is enjoying a significant increase in resources—a 24 per cent. increase in real terms since 1979.

We recognise that the pressures on the service have increased because of its success. Factors such as the ageing population, our success in making medical advances, and the additional number of nurses and doctors we have recruited all put pressure on the service. The issue also involves the operation of the resource allocation working party, which is known as RAWP.

However, tonight we are talking about the ambulance service. Since the Conservative party came to office it has increased ambulance service expenditure by almost 10 per cent. in real terms. Some of the increase has been shared by the London ambulance service, to which my hon. Friends referred, as it covers Bromley and Croydon.

A new salaried structure for ambulance men and women was introduced recently. The objective of the development was to lead to a more efficient and effective service which was more sensitive to the needs of patients. It was welcomed not only by the management side but by the trade union side of the ambulance Whitley council. There was no intention that the new salaried structure should reduce the level of service provided to the general public as a consequence of the agreement. The purpose of the salaried structure was to replace a pay system which encouraged inefficient working practice.

Both management and the trade unions recognised the importance of reducing overtime to the absolute minimum necessary for operational purposes, and the need to eradicate other working practices which frustrated the establishment of a more cost-effective and efficient ambulance service. The "all-in" salary replaced the former system under which the basic rate of pay was substantially enhanced by additional payments for overtime, shift and weekend working. In many services, but not in the London ambulance services, bonus payments were also made. Now, the basic rate covers all payments for a standard working week worked round the clock and seven days a week as operational needs may require.

The national agreement provided management with the opportunity to review critically, for example, the level of accident and emergency cover to ensure that the level provided matched that indicated by operational need. It provided for rotas to be reviewed and, where necessary, changed, using the criterion that operational necessity is the basis for staff being on duty. The agreement also encouraged the development of extended training in certain life-saving techniques. Out-patient and day centre arrangements were also to be reviewed and altered to provide the optimum vehicle and manpower utilisation. The agreement provides, too, a commitment for working practices to be kept under continuing review and for changes to be made where indicated.

Our constituency experience over the years has shown us there have been serious inefficiencies and waste in the Health Service. I am certain that our basic principle, which was carefully worked out with specialist experts who were brought in to advise, is the right way to go. There is no doubt, however, that there have been problems. The national agreement on salaried status was expected to result in major changes in the organisation and delivery of ambulance services and to lead to an improved service to patients, which is what we seek. There have been teething troubles. Although we are not resigned to that, the problems might be regarded as not particularly surprising. Regrettably, this has been happening in London recently and in other parts of the country.

The London ambulance service management has reviewed its working arrangements and reached local agreement with the staff about the changes necessary to provide the level of service it considered appropriate. It decided that there was a need to divert more resources to the emergency side of the ambulance service. My hon. Friend the Member for Ravensbourne recognised that. I am sure that he agrees that, when difficult decisions have to be taken, the emergency service must take priority

The changes effected will improve response and activation times and demonstrably provide an improved service which will be of direct benefit to patients. That must be good news. I believe that it will be welcomed by all hon. Members.

This improvement in the emergency service has, as my hon. Friend the Member for Ravensbourne pointed out, had the unfortunate effect of reducing the manpower available to carry out non-emergency duties. We believe that that is a temporary phenomenon. Active steps have been taken to recruit additional staff. Of course, new staff need to be trained to enable them to carry out these important duties. I am pleased to report—I respond to some of the questions put to me by my hon. Friend—that the London ambulance service has been able to recruit 65 new staff who are currently being trained and who will all be available between now and the end of June to carry out operational duties. Further recruitment is taking place and another 32 staff will start training at the beginning of June. The London ambulance service management is encouraged by the response to the recruitment campaign. As an interim measure, the LAS is making use also of the hospital car service, taxis and other hire cars. It has offered district health authorities the loan of ambulances, together with the cash for drivers if suitable people can be recruited locally.

On this issue, it is not a question of money. The Thames regional health authorities have made available additional resources to enable a level of service considered appropriate to be provided. This has taken account of continuing growth in demand for ambulance services, but, of course, this is an aspect in which everyone can help. There is frequently abuse of the ambulance service. I acknowledge that the Health Service has a responsibility to provide the best and most effective service it can. But those responsible for ordering ambulances, and the public have a responsibility to ensure that requests are made only for transport for those patients who meet the medical need criterion. Patients travelling to hospital by public or private transport who receive supplementary benefit or who are on a low income are entitled to reimbursement of their fares.

We regret the inconvenience and distress caused to patients who had their transport cancelled, particularly when they had no time to make alternative arrangements. We believe that the situation should now be improving and that it will continue to do so as the new staff gradually come on stream. Coupled with the real improvement that has already taken place in the quality of the emergency service in London, I am sure that this demonstrates that, within the resources available, our determination remains clear to provide the best ambulance service possible for London and for my hon. Friend's constituents. I should be grateful if my hon. Friend will convey my regret to his constituents about what has happened so far. However, I believe that the outlook with respect to the non-emergency services is improving in the directions I have mentioned. Certainly, the emergency services have improved. I hope that the new arrangement and the new salaried structure will benefit not only ambulancemen but, what at the end of the day is infinitely the most important, the Health Service patients—our constituents.

Question put and agreed to.

Adjourned accordingly at sixteen minutes to Eleven o'clock.