HC Deb 30 June 1995 vol 262 cc1222-30

Motion made, and Question proposed, That this House do now adjourn.—[Dr. Liam Fox.]

2.30 pm
Mr. John Austin-Walker (Woolwich)

I am glad to have an opportunity to talk about the London ambulance service, which has been characterised by catastrophe, crisis and chaos since the 1980s. The debate follows the publication of the all-party Health Select Committee's report, which is a damning indictment of the management of the London ambulance service. The report points out the failings of the London ambulance service's management, the regional health authority, the national health service executive, the Department of Health and the Minister.

There can scarcely have been an all-party Select Committee that has been so damning in its conclusions. The report said: Ministers represent the final link in the chain of accountability. Had the political will existed at Ministerial level, the problems of the LAS might have been effectively addressed years ago. The Minister today must show that the political will now exists.

It is not just the report of the Select Committee that has highlighted the problems of the London ambulance service. The Wells report in January 1995 and the Page report in February 1993 following the computer crash in 1992 also provided evidence, as did the Association of London Authorities in a report produced in 1991. In 1990 and 1991, the National Union of Public Employees brought forward graphic examples of the deterioration of the ambulance fleet and the problems of achieving the response times for the ambulance service.

My hon. Friend the Member for Newham, South (Mr. Spearing) has on repeated occasions in the House brought to the attention of Ministers the crisis in the ambulance service. The London ambulance service is the biggest and the busiest ambulance service in the United Kingdom—it is twice as busy as any other service. There may be a London factor that affects the service's ability to meet its performance targets, but that is no excuse for failing to provide the swift, efficient and reliable service that is essential to life in the capital city. Those failings are the result of a lack of political will, for which the Minister must answer today.

Let us look at the standard by which the Government measure ambulance services. Some may have criticism for the Orcon standards, and members of the Select Committee suggested looking at patient outcomes or the quality of care. I welcome the commitment that the Minister has made to review those matters. The Department of Health uses the Orcon standards to measure the performance of ambulance services. Those standards can be used to judge individual ambulance services, and in comparisons of ambulance services against each other. By all of those standards, the London ambulance service has failed.

Some 95 per cent. of emergency ambulances in urban areas should reach the patient within 14 minutes, while 50 per cent. should reach the patient within eight minutes. There was a steady decline in the performance of the London ambulance service from 1981 until, perhaps, last year. I acknowledge that there was an improvement in 1994 in the 14-minute standard, but there has been virtually no change in the eight-minute standard. I believe that the latter standard has much more clinical significance, particularly in cases of cardiac arrest. It would be surprising if there had not been an improvement in the 14-minute standard, given the recent injection of money for new vehicles and additional staff. The injection of resources was a major concession that was wrung from an unwilling and hostile Government. The recently recruited additional ambulance personnel have paved the way for improvements in response times, and that gives the lie to the Government's previously held dogma that resources in the service do not matter.

I am pleased to acknowledge that the Government have done a U-turn on this issue and that the Minister admitted to a Select Committee inquiry that the ambulance service was under-resourced and below establishment. He also admitted that there was the problem of an aging fleet, that the service was under-funded and that there might be a need to increase resources further. I welcome that U-turn.

There are other matters in addition to standards of performance. The Government's criteria have a great deal to say about customers and customer charters, but let us look at customer satisfaction. The Health Service Commissioner and the Select Committee on the Parliamentary Commissioner for Administration have repeatedly provided adverse reports on the London ambulance service and its failure to meet the needs of London. The former chief executive of the national health service, Sir Duncan Nichol, told the Select Committee that the situation in London was exceptional, and he contrasted its performance with the clear and efficient handling of complaints by other ambulance services.

The Select Committee took further evidence from LAS management in November 1994, which said that the ombudsman was still receiving complaints about the LAS and commented that there were clearly continuing causes of concern. Therefore, there was no absence of evidence about the problems within the London ambulance service.

The 1980s were characterised by declining standards and a decade of management failure—factors that have been universally acknowledged, even by the current management of the LAS. I do not want to dwell too much on the past and on the events of the management period of John Wilby. However, it is clear that whatever view one takes about what he was trying to do, his period in office must be judged as a dramatic failure, which culminated in the computer crash in 1992.

The Page inquiry, which was set up by the regional health authority, said that the London ambulance service management had ignored advice from many sources, including its own consultants, and had failed to listen to the views of staff. Don Page, who conducted that inquiry, said that not only had there been little consultation, but that it had caused an alarming level of demoralisation among managers and staff, and opposition from staff representatives". He also referred to the issue that is one of the prime problems in the service—the lack of accountability. He spoke about a perceived lack of accountability, but I believe there is evidence to show that it is actual. There is a lack of accountability to the regional health authority; the region lacks accountability to the NHS executive; the executive lacks accountability to the Department of Health; and the Minister lacks accountability.

I remind the Minister of what he said to the Select Committee when he was questioned by my hon. Friend the Member for York (Mr. Bayley). My hon. Friend asked: Are you ultimately responsible, by which I mean responsible to Parliament, for the quality of the service of the London Ambulance Service? If not, who is? The Minister replied: The Secretary of State, to whom I report, is responsible for everything that happens in the National Health Service. It is a pity that the Secretary of State is not here to answer for her failings to the people of London during her stewardship of the London ambulance service. It is also a pity that the Chancellor of the Exchequer and the Minister of Agriculture, Fisheries and Food are not here because, in their turn, they were Secretaries of State for Health at a time when it was obvious to everyone except the Government that London's ambulance service was collapsing around their ears.

In March 1994, in the light of the growing concern among the public and hon. Members, the Select Committee decided to conduct an inquiry. A few months later, on 19 June, there was the tragic death of a child, Nasima Begum, who had waited 53 minutes for an emergency ambulance. Even that prompted no response from the Government. There was an internal inquiry but it was not until there was an outcry in the Evening Standard and the playing on the media of tapes of the calls that the Secretary of State was forced to come to the House in October, four months after the tragedy, to set up the Wells inquiry. It appears, in the words of the hon. Member for Broxbourne (Mrs. Roe), that there has been a flurry of official activity and initiatives"— I believe as a result of the investigation by the Select Committee and the Wells report on Nasima Begum—but it is a tragedy that it needed the death of a child to prompt the Government into action.

The Select Committee criticised the narrowness of the Page inquiry; I join in that criticism. It criticised the missed opportunity of an inquiry that looked into the failure of a computer system but failed to consider the real problems of the London ambulance service. Those problems were identified by the Select Committee as ineffective management, underinvestment, industrial relations problems, a complete inability to target resources to match demand, and an ensuing attitude of negativity at all levels. An opportunity was lost following the computer crash. There had been many identifications of lack of resources, but that investigation inquired into the computer issue only and did not consider the problems of industrial relations and of resources.

I acknowledge that demand in London is greater than elsewhere in the country, and that it is increasing. I acknowledge that it is made worse by the closure of accident and emergency departments in London, almost half of which have disappeared in the past 10 years. A further 20 per cent. are due to close in the next three.

However, the principal problem is lack of accountability. Why is it that, two and a half years after the computer crash, no significant items of new technology had been brought into use in the London ambulance service? Why was there no allowance, even in the funding plans, for expenditure on a computer-aided dispatch system? Why was there no real contact with other ambulance services, such as the West Midlands ambulance service, which had a proven service and system up and running? Why was there postponement after postponement of meetings with British Telecom about installing a caller line identification system? Why was no progress made in implementing an automatic vehicle location system?

Those failures were clearly identified by the hon. Member for Colchester, South and Maldon (Mr. Whittingdale) in the press conference after he spent a night with the London ambulance service—something that many Labour Members have done—and witnessed the chaos that exists for working ambulance crews as a result of the failure of that central administrative system.

I regret that the Minister, having made such positive statements to the Select Committee, should, in his press release afterwards, criticise the Select Committee for dwelling on the past and not looking to the future. If he had read the report, he would have noticed that we dwelt very little on the past. We had considered the current position of the London ambulance service, and the problems, and had suggested ways in which they could be remedied.

I was staggered by the fact that the London ambulance service employed a firm of public relations consultants which, after the publication of the Select Committee report, issued a press release that must be one of the most damning indictments ever made of an all-party report. The press release was headed: London Ambulance Service: Developing Success Story". That does not give me a great deal of confidence that the new management of the London ambulance service have come to terms with the existing problems.

Nevertheless, I pay tribute to the management on one issue. I believe that they have begun to tackle some of the industrial relations problems. I also pay tribute to the General, Municipal, Boilermakers and Allied Trades Union and to Unison on that issue. They may have come together because they perhaps identified the Department of Health as the common enemy, but I believe that the creation of the London Ambulance Service Staff Council is a major step forward.

There are signs that the issues of rostering and unsocial hours will be tackled. Rostering will be crucial to the success of the London ambulance service in future, but unless the Government are prepared to acknowledge the significant problems that unsocial hours cause for staff, and unless those are recognised in pay negotiations, the seeds of future problems may well exist. I also draw the Minister's attention to the potential equal opportunities problems that are posed by the early finishing and early start times of some of the rosters. I believe that the Select Committee was even handed in its criticism.

Some real praise is due. It should go to the ambulance workers who have kept the service going through an almost impossible period of near collapse. Their morale is still low and it may take years to turn round. The Government continually heap criticism on the staff of the London ambulance service, blaming them for the failures and the current situation. The years of underfunding, neglect and mismanagement have left a legacy that can be resolved only with the active assistance and co-operation of the work force. I hope that the Government now recognise that. To achieve that improvement, the Government must adequately resource the service and show that they value not only the ambulance personnel, but the lives of Londoners.

2.44 pm
Mr. Nigel Spearing (Newham, South)

I am grateful to my hon. Friend the Member for Woolwich (Mr. Austin-Walker), who was a member of the Select Committee on Health and who worked very hard, for allowing me to make a short speech.

The provision of emergency services should not be the subject of any party difference; if it is, we have to ask why. I also suggest that if our democracy were running as it should do, questions, still less debates, concerning the standards of the ambulance service in any town or city would be unnecessary. Unfortunately, that has not happened.

In London, the ambulance service was transferred from the Greater London council to no fewer than four regional health authorities under the Joseph—Conservative— reorganisation of the mid-1970s. If responsibility for the service had been with a consortium of borough councils, as occurred with the fire service after the Government's abolition of the GLC, we might not be here now. That is the heart of the accountability that my hon. Friend mentioned.

Unfortunately, the problem has been going on for nine years. On 15 May 1986, the hon. Member for Ravensbourne (Sir J. Hunt), a supporter of the Government, first raised the subject in an Adjournment debate that should not have been necessary. In the nine years since, there have been no fewer than seven debates on the subject in the House; I have spoken in all those that are additional to the debates relating to the terrible dispute, which should never have happened.

I first raised the subject of the ambulance service in a debate on 31 October 1986 which was replied to by the then Under-Secretary of State for Health, the hon. Member for Derbyshire, South (Mrs. Currie). When I pointed out that there had been a 44 per cent. reduction in the number of out-patients being taken to hospitals, she stated: I am more than happy at that development. We are keen to have a better emergency service."—[Official Report, 31 October 1986; Vol. 103, c. 666] She alleged that the patient transport service had been inappropriately used, but later she could not substantiate that. This marked the first step in the terrible events that followed.

We had two debates in 1987, before the 1989 dispute, on underfunding. On 20 December 1989, the right hon. Member for Kettering (Mr. Freeman) said that the service must be run within budget. We were saying that it should be a demand-led service, run efficiently.

The staff were at their wits' end after the 1989 dispute. On 7 December 1990, I presented a petition to the House, signed by a majority of the ambulance crews, asking for a Select Committee investigation. The petitioners said: the root causes of the dispute have not been addressed … there remains a great and continuing risk to the health and welfare of all Londoners."—[Official Report, 7 December 1990; Vol. 182, c. 563.] Despite this, no action was taken and the Government did not even reply courteously to the petition. Their arrogance typified Thatcherite attitudes to all the public services.

By January 1991, things had got worse. Ten thousand out-patient journeys were being cancelled, as were the appointments with doctors. The telephone stacking of 999 calls was getting worse. Ambulance crew overtime was being cut by budget constraints to a maximum of two hours a week. Fifty ambulance officers were being made redundant because of the tendering out of patient transport services. London Labour Members asked to see the then Secretary of State, the right hon. Member for Bristol, West (Mr. Waldegrave), but he refused to see us. Despite an early-day motion, he was unmoved and so were the Government.

We had another debate on 17 October 1991. In the summer, staff were becoming worried about the consequences of the introduction of computer-aided dispatch which they said would not work. I personally sent letters warning the Secretary of State. But the thing was switched on, and of course it collapsed.

Nine months later, on 1 April, the Under-Secretary of State for Health, the hon. Member for Bolton, West (Mr. Sackville), who is here today, said in the House that no more funds would be forthcoming because enough were already being provided. I remember that you, Madam Deputy Speaker, upbraided me for a disorderly response to that claim. Yet 14 months after the collapse, in December of that year, the Secretary of State decided to provide £14 million more for the ambulance service—a tacit admission of underfunding. Too little, too late.

Ministers have been responsible—irresponsible, in effect—for what has happened over the past five to nine years. They are responsible for the incalculable number of lives that must have been lost and the terrible pressures on families and individuals affected by the dislocation and delays.

That illustrates vividly a decline in the reputation of Parliament, because we have not been able to do much, although we have used the machinery as much as we could. However, it is not Parliament but Ministers who have failed, and who have ignored the warning signs by the representatives of the people. That shows that they deserve ignominious defeat at the next general election.

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

We have listened to speeches by two hon. Gentlemen who are closely acquainted with the subject of the London ambulance service and who, especially the hon. Member for Newham, South (Mr. Spearing), know a great deal about it. The hon. Members for Woolwich (Mr. Austin-Walker) and for Newham, South both tended to trot out the old nostra about underfunding, failures by Ministers, Select Committee reports and debates, but neither of them really talked about what has bedevilled the London ambulance service for years, with disastrous consequences—the complete failure to achieve the proper co-operation between staff and management that every other ambulance service in the country had achieved years before.

Progress is now being made in that respect, and that is good news, but unfortunately it comes years after every other ambulance service in the country has achieved that co-operation. It is a great sadness to me that the capital should have been so ill served all that time because of the failure to achieve a background against which we could modernise the service and bring in the technology used by all other ambulance services, almost without exception. As a result, populations elsewhere receive a much better ambulance service.

The Government stand accused of having insufficient political will. The hon. Gentlemen cannot have it both ways. It has been said that, before the 1992 computer system crash, we tried to force the pace and that we, or rather the management of the LAS, tried to bring in the computer system without sufficient preparation or co-operation between all those who had to use it. That is fair criticism. The pace was forced, and the then management tried to make many changes in the service. Many lessons were learned as a result.

However, we must be careful not to suggest that the three years or so since then have been wasted. From the base of October 1992 a great deal has been achieved. There was a difficult and intractable situation, with bad attitudes in the ambulance service, no confidence in management on the part of staff and no proper co-operation.

It is not surprising that the new technology that the then management tried to introduce did not work, because one thing that has been amply demonstrated everywhere in industry, let alone in the health service, is that new technology, especially information technology, cannot be introduced unless all who will have to use it are perfectly satisfied that they know why it is there and the benefits that it will bring for them and for those whom they serve.

A great deal has been achieved. Since 1992, a whole new management structure has been put in place, a great many very talented and experienced people have been taken on and a whole new divisional structure has been created at the London ambulance service. A new 999 switchboard and extra radio channels have been introduced. A computerised gazetteer will be introduced in July and a new central ambulance control is to be opened in October. To prepare all that takes time. One thing we learned from the collapse in 1992 was that we cannot modernise and bring in new technology without proper co-operation. We have made a great deal of progress.

Perhaps the greatest single change and achievement in recent years has been the agreement on rostering. What particularly differentiated the London ambulance service from other ambulance services was the fact that crews were not rostered properly according to demand. There were many parts of the week and many stations where there was insufficient manning to meet what was known to be expected demand. Often, there were very long journey times because crews were coming from all over London. Crews were not in the areas in which they were needed because there was no proper system of rostering. I would like to pay tribute to management and staff for having arrived at that vital stage in what I regard as the transformation of the London ambulance service into a modern service.

Mr. Spearing

Will the Minister give way?

Mr. Sackville

I shall not give way, if the hon. Gentleman will excuse me, because I have only four minutes left.

Mr. Spearing

They voted against it.

Mr. Sackville

I would like to make it absolutely clear that, because of the agreement that has been reached and the new technology that is planned, I expect the London ambulance service to begin to reach the sort of performance standards that are routinely reached in other parts of the country.

We should also pay tribute to the London ambulance service for the fact that, although it achieved something like 50 per cent. or 55 per cent. of the 14-minute standard four years ago, month by month the figure is rising and it is now in the high 70s. It is probable that some of the divisions of the London ambulance service are already obtaining a performance level of 80 per cent. or better.

I agree with Labour Members that it is necessary to concentrate on the eight-minute standard so that urgent calls are responded to promptly. There is a measure of agreement that we need to examine the Orcon standards. We need to discover whether there is an argument for changing our attitude in respect of whether every 999 call should be responded to in exactly the same way or whether we should give special priority to the most urgent calls, especially those involving cardiac arrest.

London and other inner-city ambulance services will probably make greater use of rapid response units, especially motor cycle units and particularly where there are problems with traffic.

Mr. Austin-Walker

rose—

Mr. Sackville

I shall not give way, if the hon. Gentleman will forgive me.

In inner-city areas it is often difficult to respond in a planned way when there are traffic problems. There arelikely to be more rapid response units and we may have to change the standards that we use to reflect that because the Orcon standards say that the first ambulance to arrive should be counted in the figures.

The many reports—the Page report, the Wells report, the Select Committee report—have taken up an undue amount of management and staff time at the London ambulance service. That is a pity. Necessary as they are, they are very time consuming. In all the talk about the London ambulance service and the histrionics and accusations from the media and from hon. Members, none of us must forget that those who work at the London ambulance service are human beings who found themselves in an extremely difficult position. I firmly believe that they have come through and that the London ambulance service is in a new phase. I congratulate all those who work for the service on their successes and achievements: higher standards, better co-operation between staff and management. I am sure that we are well on the way to a London ambulance service that matches any other ambulance service in the country.

Mr. Spearing

On a point of order, Madam Deputy Speaker. Is it in order for a Minister of the Crown to criticise a Select Committee in the execution of its duty of investigation?

Madam Deputy Speaker

I do not regard that as a matter for the Chair.

Question put and agreed to.

Adjourned accordingly at Three o'clock.