HC Deb 24 January 1994 vol 236 cc137-44

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

11.13 pm
Ms Joan Walley (Stoke-on-Trent, North)

I welcome and am grateful for this opportunity to raise a most pressing matter for the people of north Staffordshire. It is the issue of why the non-emergency patient transport services contract has been let unfairly and in such a way that not only will the current level of provision for the people of north Staffordshire be cut, but the entire ambulance service in Staffordshire will be undermined, including accident and emergency, and our excellent trauma centre.

It is a bit like a "Casualty" script. I first learned of the position just before Christmas, when a constituent wrote to me: It not only degrades our jobs—which we do with pride and dignity—but also degrades the National Health Service for which our fathers and forefathers fought hard and long. Along with other hon. Members representing, north Staffordshire, who are present this evening, I have gone into the matter in considerable detail. We have met ambulance workers in Kidsgrove and Stoke; we have tabled an early-day motion; we have raised the matter in business questions; we have met the leader of Stoke-on-Trent city council, and members of the community health council; we have met representatives of North Staffordshire district health authority and the West Midlands ambulance trust.

We have met Staffordshire people who are 'worried about the future of our ambulance service. Last Thursday, we accompanied ambulance workers who had come down —in their ambulance—to present the Prime Minister with a petition bearing thousands of signatures. I raised the matter in a debate on waste and bureaucracy in the national health service, while eight workers lobbied Parliament in an attempt to retain the present level of ambulance 'work in Staffordshire.

So far, however, all that has been to no avail. That is why I particularly welcome this opportunity to put the details of the case to the Minister, together with my colleagues from north Staffordshire.

Last week, Parliament was lobbied by eight of the lowest-paid workers. They simply want to continue providing the level of service that they currently provide, and to keep their jobs without having their wages cut from £4.86 an hour to £3.26. That says it all. They care—not just about their jobs, but about the people who depend on their service. They do not want that service to be cut.

Mr. George Stevenson (Stoke-on-Trent, South)

Does not the crazy system of tendering on which the Government insist have one inevitable result? It drives down pay and conditions, and in this instance it will lead to a reduction in the excellent service that Staffordshire ambulance people have provided until now.

Ms Walley

Absolutely: my hon. Friend has put it in a nutshell.

I hope that the Minister will take full account of what has been said. It has been pointed out that the ambulance workers could end up earning nothing at all, because pay rates will be cut more and more. Why on earth, for the sake of market forces dogma, should any Government in their right mind risk dismantling a quality ambulance service like ours in Staffordshire, which has been built up over the years by local people?

Has the Minister taken the trouble to visit Staffordshire and see the high standard of work for himself—and, equally important, the current level of service? Who was invited by the Secretary of State to advise the Department of Health on quality service? Why did the Department turn to Staffordshire for advice if it does not recognise Staffordshire's excellent standards?

Is the Minister aware that the Staffordshire ambulance trust prides itself on its training, its progressive career structure for both men and women and the interrelationship between non-emergency and accident and emergency services, which complement each other? When we met the chairman of North Staffordshire district health authority, he expressed his concern about the possible implications for Staffordshire's accident and emergency services.

Why is not just the non-emergency but the accident and emergency service now under threat? Is it now deliberate Government policy to subject every part of the national health service to compulsory competitive tendering, or are there certain aspects, such as clinical services, which the Government can guarantee will not be privatised? Will the Minister give me an undertaking that in Staffordshire the accident and emergency contracts will not be put out to tender?

Where does the Minister draw the line? There is a very thin dividing line between accident and emergency work and non-emergency work, and we need to be aware of where that line is. That is why what is being done to the Staffordshire ambulance service is so important for the rest of the country, not just for people in Staffordshire.

I deal now with the details of the decision taken by the North Staffordshire hospital trust and the North Staffordshire district health authority, as the shadow combined health care trust was when the tendering process first began, to award the patient transport services contract to the West Midlands ambulance trust.

The decision means that the Staffordshire ambulance trust, which provides the service now and which also competed for the tender, is having to make redundant 72 of the most dedicated, hard-working and loyal staff anywhere in the country. I and my constituents know that. There is a sense of farce about every non-emergency worker being made redundant and 42 of the 72 being re-employed on reduced pay.

It could be said that the issue is entirely a matter for the trade unions, and that that which relates to employment legislation is a matter for Unison. I agree, and I hope that Unison, in which I have a declared interest, will be able to proceed with a legal challenge so that the transfer of undertakings safeguards, so reluctantly incorporated in last year's employment legislation, would apply. That, however, is not my concern now. My concern now is one of accountability and the way in which the specification for the patient contract service has been drawn up, handled and upheld by what I can only call bungling bureaucrats.

We should at least let the Minister satisfy himself that the patient transfer service contract has been market-tested fairly. Let him give us an assurance—later, if necessary, and at a separate meeting in Richmond house, if necessary —that what has been done was not in breach of NHS guidance, his own NHS guidance, which was modified only as recently as last November.

I believe that, once the Minister has had the opportunity to examine in detail exactly what has happened, he will not come to any conclusion other than that the contract will have to be drawn up again.

Mr. Mark Fisher (Stoke-on-Trent, Central)

Does my hon. Friend share my concern, which I hope the Minister will share, that, as the new trust is getting rid of the ambulance stations, ambulance staff will be required to take home their ambulances and park them outside their houses at night? They will have to take personal responsibility for their safety and care. If the ambulances are damaged, the staff will be personally responsible for any excess on the insurance policies. It seems an extraordinary element of a contract. I hope that the Minister will agree with my hon. Friend, our colleagues and me that it is not standard practice in the national health service, and is in breach of various staff conditions and assurances.

Ms Walley

I am grateful to my hon. Friend for raising that point. In our discussions with ambulance workers, it has been clear that it is expected that, on certain days, it will be necessary for workers to take their ambulances home with them after 8 pm.

When that was mentioned on BBC Radio Stoke, it caused an uproar among people listening to the radio. Like us, our constituents understand that, if an ambulance is parked outside someone's home at the moment, when there is an awful lot of car theft, there may be ambulance theft. What will happen on cold mornings or cold nights when it is not possible to start the ambulance because it has not been properly kept and maintained in a depot?

When we saw the new contract of employment, and when we had discussed it with the West Midlands ambulance trust, we were not satisfied with it. I do not think that the Minister can have any confidence that the new contract that has been drawn up will satisfactorily provide the patient services contract in north Staffordshire.

What has happened is lengthy, complex and technical. I know that the Minister comes from Bolton; like us, Bolton has a very good football team, although in Stoke-on-Trent we have two very good football teams. I am sure that he knows all about fair play, because he is a football supporter. I would like to ask him this evening about fair play.

Will the hon. Gentleman tell us why the EC services directive, which came into force on 1 July, does not apply in our case? Why do the Treasury guidance notes to that directive suggest otherwise? Does the Minister agree or disagree with the Treasury? Not everyone can get away with not following Treasury guidelines. Why does the regional health authority appear to be at odds with the Treasury? Why is it that the guidance notes updating those of June 1993, "Competing for Quality", endorsed by the Management Executive, have not been applied? How can there be any accountability when the Minister approves rules and regulations but they are not followed by the west midlands region and then the regional health authority and management outpost, acting as arbiter, say that the rules did not apply anyway?

There are many players in this casualty farce, which is fast becoming a tragedy in north Staffordshire. I see that the Minister is listening attentively, and I hope that he will reply to my arguments.

Just as my constituents and the constituents of my hon. Friends had no opportunity to voice their views to the national health service locally, so the Staffordshire ambulance trust has not been provided with an opportunity for a real hearing with real independent arbitration at the false arbitration which was organised recently.

There has not even been any natural justice as far as I can see, but we are asking for it through this debate. There is no way that Staffordshire ambulance trust would have been beaten by West Midlands in a fair match. Why was there insufficient detail in the original specification drawn up by the North Staffordshire hospital trust and the district health authority, subsequently to have been taken over by the shadow combined health care trust? That is bound to lead to cuts in service and quality.

Why, when Staffordshire ambulance trust offered to provide the relevant information, was that offer rejected? As a result, the Staffordshire ambulance trust had to cost its bid on the basis of actual activity levels, whereas the competing tenderers were free to make their own assumptions about the requirements. Why did a major player in the contract—Combined Health Care—appear to play no part at all?

I have recently had a letter from the chief executive of the North Staffordshire district health authority, telling me that I can expect a reply by the end of the month, but by the end of the month it will be too late to do anything about the quality of service and the jobs that we are talking about. The result, as I understand it, is that the contract will be varied to take into account mistakes made earlier. That is of no use to the Staffordshire ambulance trust, because it has lost the contract and been kicked out of play.

The result is that the hospital trust will be able to show a paper saving, a result of market testing, of about £250,000 when is comes to filling in the balance sheets on 1 April, but we say that that excludes the cost of redundancies. How can the Minister justify those redundancies? How much will the redundancies cost—about £100,000?

Nor does that clean balance sheet take any account whatever of the cost of setting up a new contract, which I guess will be about £75,000. Nor does that balance sheet take any account of the disposal of 37 good ambulances. How much will that cost? Will it cost about £500,000? How can we throw 37 good ambulances, which have been properly maintained in north Staffordshire, on the scrap heap? What kind of a health policy is that?

All those points do not even consider the demoralisation of staff, who are required to work longer hours for less money and to take their vehicles home, as my hon. Friend the Member for Stoke-on-Trent, Central (Mr. Fisher) has already said, and to provide their own insurance cover. What kind of a contract is that?

What about women and equal opportunities? We have heard a lot from the Minister and from the Prime Minister about Opportunity 2000 and women in the national health service. Indeed, a campaign was launched by the Prime Minister himself in October 1991. He was clearly talking about football again when he said: The NHS goal is to realise the potential of the female workforce within the Health Service so that we might effectively meet the healthcare needs of the population". We have a working party in north Staffordshire, of which I am proud, which considers that undertaking to bring more women into the health service and how that can be achieved. In that Opportunity 2000 document, there is even a commitment to flexible working practice. How does the Minister square that with the women who currently work part-time for the ambulance service trust in Staffordshire? Those jobs fit in with their child care responsibilities, but they are being told that, under the new contract, there will no longer be any part-time work or further flexibility.

There is a sense of deep outrage in Staffordshire, as the quick collection of thousands of names on the petition so readily showed, and especially because our community has no means of challenging the bureaucrats who have made the decision. There does not seem to be any local accountability in the national health service any more and it is time that the Minister listened to the views and wishes of local people.

I have a feeling that, somehow, the people in the NHS think that the issue of the Staffordshire ambulance service will go away. I offer the Minister an opportunity to tell us, not necessarily in the remainder of the Adjournment debate, but through a subsequent meeting, how he can work with us, understand the sense of outrage and do something about it.

11.33 pm
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)

I am pleased to have the opportunity to reply to some of the points that have been made by the hon. Member for Stoke-on-Trent, North (Ms Walley). First, I shall recap on precisely what has happened. The hon. Lady is aware that there is a system in the health service of purchasers and providers under which purchasers—health authorities—have to make their own judgments of what services they can contract for the good of patients. They make judgments based on what they perceive to be the best value for patients.

For many years now, hospitals have been able to market-test services that are provided to them. They are required to market-test certain services, such as cleaning, catering and laundry, and they can, if they so wish, put out other services to tender to see whether there are providers other than their own staff, or whoever is already providing that service, who may be able to provide a better service. That has happened in the case to which the hon. Lady has referred.

As the hon. Lady rightly said, North Staffordshire hospital's NHS trust and North Staffordshire Combined Healthcare saw an advantage in looking for better value and quality of service by putting the passenger transport service out to tender. As she has rightly said, they have awarded the contract to West Midlands. That is a perfectly normal procedure in the health service.

The hon. Lady may remember that Staffordshire won an ambulance contract from West Midlands and now operates the service in Wolverhampton. That is because a decision was taken that the service worked better in that way. I repeat that that is a perfectly normal procedure. Every hospital has to decide who should provide the various services for it, and it must decide on the basis of how it perceives the value of that service to patients.

Ms Walley

Can the Minister tell us why there was no lesser quality of service in Wolverhampton but we will have a lesser quality of service in Staffordshire?

Mr. Sackville

I would certainly dispute that. I have looked into the matter. As the hon. Lady is aware, officials of the region and of my Department have looked into the question whether the contract was properly let, and have concluded that both ambulance services were bidding on the same basis and against the same specification. There is no evidence that I have found—if I had found any evidence, I should be most concerned—that there was some inequity of specification in the basis on which they were bidding.

Clearly there are points to be made about wage structure. The hon. Lady has told the House that the wages offered are a quarter less than those currently being offered. She should be aware, however, that, although the basic wage is lower, there are allowances that make up the total remuneration to a figure above what is now being paid. [Interruption.]I am assured of that, and I have no reason to think otherwise.

If the hon. Lady cares to investigate the wages under the Wolverhampton contract, she will find that that is exactly the difference between the wage structure of Staffordshire and the wage structure of the West Midlands ambulance service. The hon. Lady will also be aware that, as of now, some 49 of the Staffordshire employees have applied for jobs with West Midlands in relation to the contract.

The hon. Lady asked me certain specific questions, some of which I shall try to deal with now, and others of which I shall deal with in writing or at a subsequent meeting if she wishes. She asked whether I have visited to find out what an excellent service is being offered. The Staffordshire service is one of the very few ambulance services that I have not visited in the past 18 months. I am sure that I shall have an opportunity to do so soon. I have no reason to believe that the service was defective. I am well aware that there is an excellent accident and emergency service in Staffordshire, and I have no reason to suppose that that is undermined or threatened by the arrangements. I certainly have no evidence of that.

The hon. Lady asked me whether I could draw a line under what is capable of being put out to tender. The answer is that there is no line of which I am aware. If, in the opinion of any hospital, a service would be better provided for the benefit of patients by some other provider, the hospital has the opportunity to explore that possibility. It is also possible for emergency services to be put out to tender.

The hon. Lady may be aware that the contract for the Coventry accident and emergency service is now out to tender, and I am told that Warwickshire is bidding for it. I do not know whether it will be successful, but the local authorities have decided that they think that it may be possible for someone else to do a better job. That is the reason why they are there. The Secretary of State appoints chairmen of health authorities precisely to make such decisions.

The hon. Lady asked whether I was satisfied that the contract had been properly let—whether it breached any guidelines or rules. I am assured that it does not breach EC directives. It does not breach other rules. I am told that the proposal is that it should come into force a month later, subject to the arbitration that took place at the region because there was a technical breach of the six-month rule in the original arrangements.

The hon. Member for Stoke-on-Trent, Central (Mr. Fisher) asked me about insurance and responsibility for vehicles. I cannot answer his question now, but shall do so in writing. Clearly, it is important that, if there are such changes, they should be separately negotiated. I am afraid that I have no knowledge of that at present.

Staffordshire ambulance service provides an excellent accident and emergency service. The figures suggest that it has a high Orcon response level. I have no reason to suppose that the service is being undermined by the arrangements. Such a change obviously produces unwelcome disruption. I hope that everyone involved will take the trouble to ensure that as many staff as possible can be redeployed, and disruption and problems are kept to a minimum.

I am afraid that, after investigation, I am unable to say that the contract is in breach of the rules.

Ms Walley

What sort of inquiry has the Minister carried out? On what basis has he said what he has just said to the House?

Mr. Sackville

As always in such cases, following the hon. Lady's intervention, I asked the officials in my Department to look carefully at the arbitration to find out exactly what was said and agreed. and to look into the allegations that the contract was breached. The answer that I have come up with is that it was not. Therefore, I have no reason to accede to the hon. Lady's request to intervene.

Question put and agreed to.

Adjourned accordingly at nineteen minutes to Twelve midnight.

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