Ambulance Personnel (Long-service Awards) (Hansard, 8 March 1994)

§ Mr. Colin Shepherd (Hereford)
I thank my hon. Friend the Under-Secretary of State for Health for coming to the House.

§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)
It is a pleasure.

§ Mr. Shepherd
I am glad that it is a pleasure, because it is also a pleasure for me to discuss an important and much-neglected subject, which may be small in span, but which means a great deal to many people.
My hon. Friend will know, as one who regularly walks through the Palace that at the entrance to the Terrace, there is a magnificent display of medals, which cover examples of virtually all the medals in existence, and many that used to be awarded. There are two spaces in that display and they are significant. One of the spaces is for a medal which is in existence, but is not displayed; one is because no medal exists. There is an existing medal for long service and good conduct in the fire brigade.
The medal which exists and is not displayed is the police service long service and good conduct medal, but the medal which is missing is for the ambulance service long service and good conduct medal. Tonight I want to address that piece.
My introduction to and contact with the ambulance service began some 20 years ago, when I came into the House. Before that, my only contact with the ambulance service was as a client at the age of eight when tender hands picked me off a fence on which I had impaled myself. I was enormously grateful and I am still most grateful for their care now.
My good friend and helper in the constituency, Harold Morgan, was a leading ambulance man who inducted me into the mysteries of the ambulance service, for which I have enormous gratitude. I remarked to him that I had not received a single complaint of failure on the part of the ambulance front-line personal of the Hereford and Worcester ambulance service in the entire time that I have been in the House. There may have been criticisms sometimes about shortcomings in administration, but the record of the ambulance men on wheels or on the ground is clean and remarkable and I can only call it meritorious conduct.
I pass the ambulance station outside Hereford each time on my way into the city. As all of us who represent rural constituencies know, we travel a great deal around them and I pass that station often. I cannot help but think every time I do so that it is all too easy to take those people and that service for granted. It may be right that we should take the service for granted, but I do not think that it is right to take the personnel for granted. We ask them to do a great deal for us and, on occasions, when we are in no condition to do it for ourselves.
I can do no better than to demonstrate the regard with which the ambulance personnel are held—certainly in my part of the world and I have no reason to believe that it is any different anywhere else—by quoting from a letter written by a general practitioner from Ledbury, which is 260 not in my constituency, but is not a million miles from it. The letter concerns the service of leading ambulance man Kevin Pendlebury Bowe and alas, was read at his funeral on 1 March.
The general practitioner wrote: Although all the local ambulancemen inspire confidence, the sight of Kevin arriving during a tricky situation always allowed us to breathe a sigh of relief. He was unflappable, good humoured and supremely competent. He obviously took a great interest in his work as a paramedic—he was one of the first of this relatively new breed of ambulancement that we came across—but he always excelled. This was never at the expense of compassion and of this I can speak as one of his transported patients as well as a colleague. My understanding of my constituents and others who are in the ambulance service is that that is not necessarily exceptional. It is the rule. I can think of no better tribute.
One of the great mysteries is why we are discussing the subject at all. I look in the telephone directory and see that the advice for emergencies is to ring 999 for the police, fire and ambulance services. Those are all front-line civilian services. Perhaps the work of the police is that much closer to the front of our consciousness because it is extremely well covered by the media—sometimes I think that, for the police's sake, it may be too well covered, but that is another story.
The fire brigade always makes marvellous television, with big red fire engines, flashing lights, great turntable ladders, belching hoses, people running about, smoke and fire. That is all good stuff, with drama and visual impact, and it is always effective.
However, always in the background is the ambulance service. It is the ambulance men who have to pick up the bits—often the bloody bits. As that involves intensely personal suffering and agony, we are usually treated only to the sight of a stretcher being loaded into the ambulance and the doors being shut. Nobody really understands the extent to which the ambulance personnel are involved.
As for comparability, the police are often exposed to violence and to physical and psychological risk. No one gainsays that; theirs is a difficult profession. Firemen, too, are frequently at physical and psychological risk. We cannot ignore the dangers in areas afflicted by terrorism, where there is also the risk of violence. However, we must not forget that the discreet, unforthcoming ambulance personnel are also at risk of violence and of psychological trauma as they go about their work. As for physical risk, let us not forget that not so long ago an ambulance man was killed on active duty in Leicester.
In Northern Ireland the mischief of the terrorist is a particular hazard. Ambulance men are not alone in facing that; the police and the fire service also suffer—but they all find that it induces nervous stress. Even in tranquil Herefordshire, even in the calm pastures of my part of the world, ambulance personnel have been shot at in the course of their duty. Nowhere and nobody is free from that risk.
I mentioned the psychological risk. It could be said that continual attendance at nasty road traffic accidents hardens the mind and calluses the attitude, so that it all becomes just so much more meat. But I cannot accept that that is true. All three front-line services—the police, the fire brigade and the ambulance service—attend traffic accidents. They all have their parts to play, and the experience is always traumatic.
I have only to reflect back on especially horrendous incidents such as the recent tragic accident on the M40 involving a minibus full of schoolchildren from Hagley, 261 which caused immense traumatic stress among the ambulance personnel involved. Ambulance officers are then seriously involved in counselling to unscramble the psychological mess that has been created. The trauma cannot be overcome simply by hardening, callousness or anything of that kind. Those tragic events always get to people.
All the time, as the work goes on, there is a continuing growth of expertise, which is developed through training, training and more training. That shows in the results, in the performance and in the delivery of service.
There can be no doubt that there is comparability between the front-line services. Even if an ambulant man wrecks his back and injures himself to the extent of disablement, perhaps by lifting victims in awkward circumstances, so that he has to be moved from the front line to the lighter duties of taking non-ambulance patients from home to hospital, so be it. They are the sympathetic interface between the health service and patients, who are often elderly and confused. It is a help if people are transported with care, consideration, sympathy, friendliness and the skill which is so often shown.
I first started chasing this medal in the early 1980s. My instantly get-atable files are traceable to 1987, but I recollect that I started this in the early 1980s. I recall receiving a letter from the chief ambulance officer of the Hereford and Worcester ambulance service, Cliff Orme, dated 7 September 1977 in which he recalled our previous exchanges on this matter. He said: Sadly incidents such as the massacre at Hungerford …clearly indicate the danger and responsibilities facing ambulance services who work in the 'front line' with their colleagues in the other emergency services. It has for some considerable time been the view throughout the rank and file of ambulance services in the U.K. that a long service medal should be awarded to ambulance staff, indeed Chief Ambulance Officers I know have pressed for this over a number of years without any success. The chief ambulance officer also referred to a letter that I wrote to the Prime Minister in August 1987. The Prime Minister replied to me saying: This question has been considered several times in the past and most recently last year"— that was 1986— Although there has been some sympathy with the suggestion, particularly in view of the dedicated service by ambulance staff, it has consistently been rejected mainly because it was felt it would be invidious to single out ambulance staff for such an award when many other groups of NHS staff give equally long and loyal service. However the Secretary of State for Social Services recently asked officials to give further thought to the feasibility of a long service award for all NHS staff. In view of the number of interests involved, including possible repercussions on other public services, it will be some time before a final decision can be made. I let that run while I waited for the consultation and discussions.
I then wrote again one year later. In a letter dated 19 July 1988, my hon. Friend the Member for Derbyshire, South (Mrs. Currie), who was then the Parliamentary Under-Secretary of State for Health, said: I am afraid this process is taking some time, but we do hope to resolve this issue in the near future, and we will take account of the points you have made. Time rode on and I had to take up the matter again. I controlled my patience as best I could. In November 1991, 262 I wrote again to the Secretary of State for Health. The present Secretary of State, in her manifestation as Minister for Health, wrote a letter to me in December 1991 saying: The deliberations referred to in the then Prime Minister's letter to you of 18 September 1987 resulted in the conclusion that the introduction of a centrally sponsored long service award for NHS personnel generally would not be appropriate. Further consideration is, however, now being given to the possibility of introducing a long service and good conduct award solely for front line staff in the emergency ambulance service, similar to the Crown awards already granted to members of the police service and fire brigades. A specialist working group has recently been set up to consider this, and held its first meeting on 2 December. I thought that progress was being made and we were getting there but it was not so.
I let that run for a little while until I took the matter up with my hon. Friend the Minister who is here tonight. He wrote to me, referring to a letter that I had written to the Secretary of State in May 1993. I must compliment my hon. Friend—he must soon be qualifying for his own long service and good conduct medal in the Department of Health. He said: The working group"— mentioned in the Secretary of State's letter of 6 December 1991— completed its work last year and recommended that a Crown recognised Long Service and Good Conduct Medal should be instituted for staff who have served for 25 years in the emergency ambulance service. I am inclined to accept the report's recommendations but have first asked officials to consult NHS management about the report. I drew attention to my concern that 25 years was a long time, given the physical work involved and given the comparison with the armed services, which has 18 years, and the fire service, which has 20 years. I said that most people entering the ambulance service came in as mature people aged about 25. Therefore the chance of reaching 25 years—that is, 50 years of age—without doing themselves an injury was going to be difficult.
I am pleased to say that my hon. Friend the Minister responded to the point for one reason or another—maybe I was not alone in making it. My hon. Friend wrote to me on 25 August 1993 saying that I would be pleased to know that, following the consultation exercise, officials were drawing up a formal proposal for a medal to be on the basis of a qualifying period of 20 years, on a par with the Fire Service". I fel that that was good news. I waited in keen expectation and anticipation, but, not hearing anything, I took the matter up again at the start of this year.
My hon. Friend again responded to me with a letter on 17 February. He said: I am pleased to say that a proposal for a Crown-recognised Long Service and Good Conduct Medal has been forwarded to the appropriate quarter for consideration and it is hoped that this will result in a positive recommendation to the Queen. My hon. Friend went on to say that there were many hurdles to be overcome before he could say whether the proposal would be accepted.
My purpose tonight, after my rather long preamble, is to say that the ambulance service has been patient. There have been many hurdles, consultations and considerations and still we are going to the "appropriate quarter" and there are "many hurdles" to be overcome.
Will my hon. Friend give an insight into what the appropriate quarters for consideration might be? What are the many hurdles which have yet to be overcome? I would 263 like to know how to address the hurdles? What must I do to try to secure a well-deserved medal for long service and meritorious conduct in the ambulance service?
It has long been the wish of the ambulance service that it be regarded equivalently with the police and fire services, and I hope I have demonstrated its patience. In a sense of frustration some years ago, the chief ambulance officers themselves recognised that yearning and introduced their own recognition of long service and good conduct. However, we all know that that is less satisfactory than the real thing—the Queen's award or the royal warrant—which I am seeking tonight.
My hon. Friend will appreciate that the chief ambulance officers' award cannot be worn on the left breast, but must appear on the right. That may make it stand out in a crowd, but there will always be the feeling that it is somehow second best, and that the best really should have pride of place on the left breast, as is the case with other medals and in other services.
We might be treading tonight down a path which has been trodden before. The 12th stricture of the royal warrant for the fire brigade long service and good conduct medal is that it is a condition of the award that the grant of any unofficial or local long service or good conduct medal for wear in such a Brigade shall be discontinued, and that any unofficial or local long service medals, if already granted, should not be worn by a recipient of Our Fire Brigade Long Service and Good Conduct Medal. I am certain that those who wear the unofficial good conduct and long service medal would gladly put it to one side in favour of something which held the royal warrant, which they could wear with even greater pride.
The royal warrant for the fire brigade medal seems to me to be an excellent model for the derivation of a royal warrant for an ambulance service long service and good conduct medal, and perhaps that could be used quickly. On 1 June 1994, it will be the 40th anniversary of the institution of a medal honouring those who have rendered long and meritorious service as members of the Fire Brigades of the United Kingdom, the Isle of Man and the Channel Islands". I am sure that the police and fire services will join enthusiastically in celebrating the inclusion of the ambulance service in this form of royal and public recognition. Can we celebrate that 40th anniversary with a birthday present for the ambulance service and fill the empty space at the entrance to the Terrace?

§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)
It is a pleasure to be here to reply to my hon. Friend the Member for Hereford (Mr. Shepherd). I have never said that before about an Adjournment debate and I do not expect to do so again.
Ambulance men and women deeply deserve recognition for the wonderful service that they give to the public. I shall not attempt to match the eloquence with which my hon. Friend has described what they do, save to say that we have a magnificent ambulance service which has gone from strength to strength in recent years.
264 Many people have not yet become aware that in almost every front-line ambulance that answers a 999 call there is a paramedic—a man or woman who is highly trained in saving life through all sorts of manoeuvres and techniques that even a general practitioner might not always attempt. Indeed, it has sometimes been known for the general practitioner to defer to a paramedic on his or her arrival. Paramedics know precisely what to do to maintain life and to stabilise patients in those first vital moments after a medical emergency or an accident and before getting them to hospital.
Ambulance men and women deserve the great gratitude of the public. Many people, including my hon. Friend, have had first-hand experience of what they achieve and his area's ambulance service, the Hereford and Worcester, which is led by a legend in the ambulance world—Mr. Cliff Orme—is a very fine example. It has done extraordinary things to achieve high levels of performance in the time within which it responds to 999 calls. It has an excellent patient transport service for non-emergency cases and has gone further because it is at the forefront of involving the public in life-saving techniques. When I last visited that service I was told that 10 per cent. of the people in one large town in the area had received first aid training —a remarkable performance and one that is probably not matched anywhere else.
I am aware that Cliff Orme, in his distinguished time in charge of the Association of Chief Ambulance Officers, campaigned for the medal that we are discussing. In the short time remaining, I can tell my hon. Friend only that there has been progress. There has even been progress in achieving a Crown-recognised long service and good conduct medal since I last wrote to him. I cannot answer his question about the appropriate quarter to which the matter was forwarded, but such matters are processed somewhere in the Byzantine passages of the Cabinet Office, whence it will have to be forwarded to Her Majesty, whose ultimate decision it is.
I agree with my hon. Friend that there is every reason to think that the ambulance service should receive such recognition, in line with the fire, police and other services. I cannot say what the outcome will be, for the reasons that I have outlined, but I will do everything that I can to encourage the process.
In our role as junior Ministers—I think that we are sometimes described as "Parly Charlies"—we are always slightly insecure. In the presence of the Whip, I can say that we never know when we may be shuffled out or elsewhere, or when we may have to change our duties. However, in the remaining time for which I hope to stay in my role as a junior Health Minister with responsibility for the ambulance service, if I achieve one thing I hope that it is a long service and good conduct medal for that service.