§ Mr. Nigel Spearing (Newham, South) (by private notice)
To ask the Secretary of State for Health if she will make a statement on the breakdown of the recently introduced control procedures of the London ambulance service.
§ The Secretary of State for Health (Mrs. Virginia Bottomley)
I am very concerned about recent reports relating to failures in the London ambulance service. These were caused by exceptional circumstances which led to a breakdown in the computer-aided dispatch system earlier this week. I have had urgent talks with the London ambulance service, and with the South West Thames regional health authority, which is responsible for overseeing the LAS. They have assured me that firm action has been taken to tackle these difficulties and make sure they do not happen again.
The computer-aided despatch system, which cost £1.5 million to install, has the potential greatly to improve the service to patients. Ambulances can be despatched in seconds rather than minutes. However, it is obvious that there are initial technical problems. The LAS will therefore establish, from 11 pm tonight, a support system, involving, where necessary, direct voice contact between the control centre and ambulances. This will build in an extra safeguard to ensure that ambulances are on their way. This system will remain in place until we are satisfied that the problems with the CAD system have been remedied.
The LAS has also decided to conduct an external inquiry into the operation of the CAD system and the circumstances surrounding its failure on Monday and Tuesday of this week. Full details of this inquiry will be announced as soon as possible, but it is envisaged that it will be headed by a chief ambulance officer from another metropolitan region. The inquiry will identify lessons to be learnt for the operation and management of the service.
The House will want to know that, as a result of recent difficulties, staff levels in the LAS control room have been increased—[Interruption.] The House will also want to know that earlier this afternoon the South West Thames regional health authority accepted the resignation of John Wilby as chief executive of the London ambulance service. Martin Gorham, deputy chief executive of the regional health authority, will take over as acting chief executive of the LAS immediately until a permanent replacement can be recruited.
My overriding concern is to ensure that proper management is in place in the LAS so that the problems which exist can be dealt with speedily and effectively. In particular, I am concerned that the problems with the computer-aided despatch system are solved and that, in the meantime, the support system that I have already described is functioning properly. Mr. Gorham will be reporting regularly, on behalf of the board of the LAS, to Chris Spry, the chief executive of South West Thames RHA. In turn, he will be reporting to Duncan Nichol, chief executive of the NHS.—[Interruption.] This reporting system will ensure that Ministers are kept in proper and regular touch with progress.
The problems in the London ambulance service do not result from a lack of resources.—[Interruption.]
§ Madam Speaker
Order. Members below the Gangway must come to order while the Secretary of State is making this very important announcement—and that includes Members on both sides of the House.
§ Mrs. Bottomley
I well understand that London Members are concerned about these matters, but I find it difficult to understand why they should seek to interrupt throughout my statement. I appreciate that many London Members, rightly, want to be sure that their constituents will have the benefit of a good ambulance service.
The problems in the London ambulance service do not result from a lack of resources. Funding this year is up 9 per cent. over last to nearly £70 million. In 1991–92, Government investment enabled the purchase of 130 new vehicles. There will be another 80 this year. The number of fully trained paramedics has risen in the past two years from three to 326.
The Government have invested substantially in the London ambulance service. The capital needs and deserves a better return on this investment from the service than it is currently receiving. It is a job for management and the work force to see that this is achieved. A better ambulance service for London is our top priority. The action that I have described today will help to bring this about.
§ Mr. Spearing
Does the Secretary of State agree that, over the past few months, she has had representations from London Members on both sides of the House, from the Back Benches and the Front Benches, about the progressive deterioration in the London ambulance service? Is she aware that, in June 1991, her predecessor refused to see a deputation of London Labour Members about the shortcomings of the ambulance service in general, and in particular the failure of the £3 million first computer despatch system? Does she recall that, on 3 June, 17 July and 14 September of this year, I wrote to her warning of the impending crisis in the LAS? On 28 September, a junior Minister replied, blaming ambulance personnel for some of the problems and stating that the computer system was functioning correctly.
Is the Secretary of State aware that, on 14 September, I spent over an hour with the chairman of the London ambulance board, telling him that, if in October he introduced new rosters, as was his intention, together with activation of the computer-aided despatch system, he would be gambling with the lives of Londoners?
Do not all these matters show that a terrible disaster was wholly preventable and that the Secretary of State's action in bringing into the picture members or officers of the South West Thames regional health authority was entirely inappropriate as they are responsible for the appointment of the London ambulance board, which is responsible for this mess? Will the right hon. Lady appoint a well experienced and well regarded ambulance officer from outside London to take over the direction of a vital service to Londoners, being accountable directly to her and through her to the House and to the people of London?
§ Mrs. Bottomley
I think that I have made it clear that I well understand the concerns of London Members generally and those of the hon. Gentleman in particular. There has been a substantial investment in the London ambulance service. Many Members who have ambulance services operating in their constituencies that are not within the London service would envy the investment in 1015 terms of computer equipment and vehicles that has taken place in London. About one third of the fleet will be replaced by 1993. The fact is that the service, especially the new computer system, has suffered from considerable teething difficulties. That is why I have made my announcement this afternoon.
As for the hon. Gentleman's point about the skills of a chief ambulance officer benefiting London, that is why I have announced that there will be an external inquiry into the operation of the system, the circumstances surrounding its failure this week, and any lessons that can be learnt from the operation and management of the service. I shall announce in the near future who that officer is.
§ Mr. Richard Tracey (Surbiton)
There is undoubtedly a long catalogue of complaints from London Members of Parliament on both sides of the House about the London ambulance service. Is it not time that my right hon. Friend announced a completely independent and deep-seated inquiry into the working of the ambulance service in London? We understand that there are far more calls for ambulances in London than anywhere else in the country. Far more people leap for a telephone to call an ambulance in London than elsewhere. Will the inquiry look into the working relationship between the officers and the union in the London ambulance service?
§ Mrs. Bottomley
My hon. Friend identifies what has been a particularly difficult area for the London ambulance service—some of the management issues and the relationship with those providing the service. I hope that effective management, good communications and an understanding of the new system will lead to full co-operation and an improved service. The vast majority of those working in the ambulance service want to give the standard of service that is routinely available in other parts of the country, often with fewer resources than are available in London. I am confident that the arrangements that I have announced will result in clear improvements. My hon. Friend the Under-Secretary of State, the Member for Bolton, West (Mr. Sackville), who has responsibility for the London ambulance service, will be more than happy to speak to any hon. Member about particular constituency problems.
§ Mr. Jeremy Corbyn (Islington, North)
Will the Secretary of State give us an assurance that the new management of the London ambulance service will listen seriously to those who have given a lifetime of work to the service, instead of condemning them and attempting to break up the union organisation, as the unlamented Mr. Wilby was trying to do? Will she also assure the House that she will no longer even countenance any proposal to create an NHS trust out of the London ambulance service but instead will give Londoners an efficient, safe and accountable ambulance service, which is so desperately needed and which so obviously has not been provided for the past few years?
§ Mrs. Bottomley
The answer to the first part of the hon. Gentleman's question is yes, good communication is essential to good management. The answer to the latter part of the hon. Gentleman's remarks is no. Many hon. Members' constituencies benefit from an ambulance trust, providing a first-rate service. I advise the hon. Gentleman 1016 to visit Essex, Northumbria and many other areas to see what can be achieved when an ambulance service becomes an NHS trust.
Mr. John Gort (Hendon, North)
Will my right hon. Friend, who knows that I have put several cases to her recently, bear in mind that her explanation does not adequately explain why a 92-year-old lady should have to wait seven hours for an ambulance despite the fact that crews were available throughout the day only a few miles away? What is the minimum time that people can now expect to wait for an ambulance in the light of the new arrangements that my right hon. Friend has just announced?
§ Mrs. Bottomley
I agree with my hon. Friend's comments about the inadequate service that was available, but some of the stories that have been alleged about that day have not been borne out by the facts. However, I accept that, as things are, the service is not delivering good enough results. My hon. Friend will know that we expect 95 per cent. of calls to receive a response within 14 minutes. There are also standards to be met regarding the time that it takes to activate an ambulance once a call has been received. That is why it is so important that we have the 16 extra call takers at the headquarters in order to ensure that people do not have the unacceptable response of a telephone answering machine. We have sufficient lines and sufficient call takers.
Exceptional circumstances arose on Monday and Tuesday this week. It will take us longer to identify all the aspects of those events, which is the reason for the external inquiry. I may say that there was a dramatic increase in calls and a large number of exception messages, in which ambulances did not notify their status to the headquarters.
§ Mr. Malcom Wicks (Croydon, North-West)
Ambulance staff in Croydon telephoned me this morning to tell me what has been happening, and some said that there had been tears this week because of the appalling situation. I was told about a woman who suffered a heart attack and who, after waiting 45 minutes for an ambulance, died after her husband took her to hospital by car. Does not the Secretary of State agree that Londoners are in pain and misery, that some are at risk, and that many have died? The right hon. Lady has been warned about the situation for months. We have met with complacency, and my questions have not been answered by the Department. I say with sadness that complacency and inaction have cost the lives of too many Londoners.
§ Mrs. Bottomley
I have made it clear to the House that we must await the results of the great investment made in the London ambulance service. It is not a good enough explanation to say that there are unique reasons for inner-city anbulance services delivering the required standards all over the country but failing in London. In Greater Manchester, 97.4 per cent. of responses are made within 14 minutes, but in London the figure is only 64 per cent. In Merseyside, it is 94 per cent., and in the west midlands it is 92 per cent. Other inner-city and urban areas deliver results that are not achieved in London. We have made clear our investment commitment and announced the external inquiry, and must now deliver the result.
§ Mr. David Mellor (Putney)
Recently I wrote to my right hon. Friend to draw her attention to a series of incidents in my constituency that caused widespread 1017 concern when the London ambulance service failed to arrive in proper time to deal with casualties. In one case, in which a constituent had a heart attack and subsequently died, it took 45 minutes for an ambulance to reach him. That suggests that London ambulance service failures are not isolated and cannot be blamed merely on a computer system, but are systemic. Does my right hon. Friend agree that they call for top-to-bottom reform?
While it is helpful that responsibility is carried by those at the top of the organisation, will my right hon. Friend confirm that there is nothing for the unions to be proud of? Why has it taken so long for new rostering arrangements to be introduced? I hope that my right hon. Friend—
§ Mr. Mellor
It is a jolly good thing that the hon. Member for Bolsover (Mr. Skinner) is not in charge.
I hope that my right hon. Friend agrees that it is crucial that the crisis that has arisen is not used as a tit-for-tat battle in the service's industrial relations problems, which have continued for far too long, but provides an opportunity for everyone to look to their consciences and to give the people of London the ambulance service which they deserve and which they do not currently have.
§ Mrs. Bottomley
My right hon. and learned Friend is exactly right. The real progress that we want to make can be achieved only if management and staff co-operate and work constructively together. There must be more effective and harmonious dealings within the London ambulance service.
My right hon. and learned Friend mentioned the new rostering arrangements, which should result in 20 per cent. more ambulances being on the roads in peak periods. However, we have not been making the staff side progress with that practical improvement which the management wants, and which would benefit London and Londoners.
§ Mr. Jim Dowd (Lewisham, West)
Does not the Secretary of State realise that simply recounting stories about increased resources and efforts by the London ambulance service cuts no ice with Londoners whose simple test is whether or not the service works, and it is patently clear that it does not. This is merely the latest episode in the deterioration of London health services.
Can the Secretary of State give an assurance that no one telephoning a 999 service—which by definition will be in exceptional circumstances—will receive a response other than a human operator, and that no caller will suffer the trauma and distress of having to hang on, listening to an answering machine, while waiting for a loved one to receive emergency treatment?
§ Mrs. Bottomley
I think that I have made it clear that there are to be 16 more call takers for the London ambulance service. About half that number have already been appointed. They have experience in the field, and they are also receiving careful training.
I am satisfied that sufficient lines are available. I entirely agree with the hon. Gentleman that calls should be promptly received, promptly answered and promptly responded to, and it is clear that improvements are needed 1018 at every level in management, with co-operation and determination to provide a first-class service throughout the ambulance service.
§ Mr. Harry Greenway (Ealing, North)
Does my right hon. Friend accept that not only the emergency ambulance service but the ordinary service is unsatisfactory and causing great distress across London? Many elderly people —and others who are not so elderly—sit at home waiting to be collected for an urgent hospital appointment by an ambulance that never arrives. After receiving hospital treatment, people find themselves waiting for an ambulance that never arrives to take them home.
Will my right hon. Friend assure the House that there are sufficient ambulance men in London to deal with both emergency and ordinary cases? Will she also ensure that the inquiry looks into attendance levels, and into whether ambulance men are fit to be at work all the time? Should not that factor be considered?
§ Mrs. Bottomley
I think that the entire London ambulance service will benefit greatly from the advice of a chief ambulance officer from outside London, who will be able to review some of the difficulties and advise on the way forward. As I have said, however, many hon. Members take for granted an ambulance service that is resourced less generously than the London ambulance service and achieves a very much higher standard of service.
My hon. Friend the Member for Ealing, North (Mr. Greenway) asked in particular about absentee rates. It is cause for concern that, in the London ambulance service, the rate is running at about 10 per cent., compared to about 6 or 7 per cent. in the rest of the health service.
§ Ms. Joan Ruddock (Lewisham, Deptford)
The Secretary of State said that resources were not an issue. How does she explain the case of my constituent, 18-year-old Keeley Donaghy, who died of an asthma attack while her frantic mother rang the ambulance service between 4 and 5 am on 4 July this year? An ambulance was indeed dispatched within a reasonable time, but it could not find the address. We understand that the reason— referred to by the coroner—was the fact that there was no local ambulance available at that time in the morning, and those who were sent were not familiar with the geography.
Surely the Secretary of State's inquiry must examine staffing levels and the number of operational vehicles available at any one time.
§ Mrs. Bottomley
I offer my great sympathy to the hon. Lady's constituent, who underwent a very distressing, frightening and tragic experience.
The computer-aided despatch system is intended precisely to ensure maximum use of the available ambulances. Its teething difficulties are the reason why we have taken half a step backwards and supported it with radio contact. The very large investment of £1.5 million in the London ambulance service, however, was made with the precise purpose of enabling ambulances to be located, and to be put in touch immediately with callers in their vicinity.
§ Mr. John Marshall (Hendon, South)
Does my right hon. Friend accept that many people in London believe that the problems of the ambulance service predate this week's difficulties with the computer? Given that the service receives such good resources, must not the problem 1019 be one of management or bloody-minded employees? The people of London will welcome my right hon. Friend's inquiry, which will lead to a much better service in the months to come.
§ Mr. David Blunkett (Sheffield, Brightside)
I congratulate my hon. Friend the Member for Newham, South (Mr. Spearing) on his tenacity and his wholly justified pursuit of this issue over the past six years.
Will the Secretary of State join me in offering further congratulations to the Daily Mirror on its excellent exposé of what has been happening over the past few days? I suspect that, without that, we would not have heard this statement today. Does she agree that the time for prevarication is over, that lives have been lost arid that people continue to be at risk? She should immediately introduce outside managerial expertise, not merely for the inquiry but to run the service in the interim period.
Does the Secretary of State agree that she failed to respond to the clear signs of crisis in the service or to the appeals of hon. Members? She refused my request in a letter of 16 September for a public inquiry, but wrote to me instead about the computer system, saying:When fully operational, this system will result in improved response and call waiting times. Calls will be answered in seconds rather than in minutes.Does she agree that that not only proved to be incorrect but led to the situation that arose this week, when people have died? Their demise and their families' bereavement could have been avoided.
On Friday, the closure of London hospitals was announced. Yesterday, we learned of the scandal of what is taking place in the west midlands. Does the Secretary of State agree that the time for complacency and neglect is over and that she should act in the interests of everyone, as Conservative and Labour Members have suggested?
§ Mrs. Bottomley
About £70 million is being spent on the service in London. A third of its vehicles will be new by next year and it will have an extra 326 paramedics. I think that I made it clear that other parts of the country would envy such investment.
I do not accept the hon. Gentleman's view that the computer system is without value. It clearly stands to benefit London and Londoners. It has had teething difficulties, and we shall have to think further about how we can ensure that it works properly and that all the staff co-operate with the new working procedures. Teams throughout London must understand that, for the computer to work properly, they must press the buttons at the right moment and be in touch with the centre. Management must effectively lead that change so that Londoners can benefit. Martin Gorham, deputy general manager of South West Thames regional health authority, will be acting, and we will have the benefit of the chief ambulance officer from another metropolitan area to advise us.
The hon. Gentleman mentioned the west midlands. The requirement is that 50 per cent. of calls should be answered within eight minutes. It is managing to answer 72 per cent. of calls. Ninety-five per cent. of calls should be answered within 14 minutes, and the west midlands is just meeting that target. It is setting a good example in ambulance services. If we can get the London service to match the west midlands service, all Londoners and hon. Members should be content.