HC Deb 26 November 1996 vol 286 cc239-48

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

9.24 pm
Mr. Bill Walker (North Tayside)

I thank Madam Speaker for giving me the opportunity to have this Adjournment debate.

My constituent, Mrs. Susan MacKenzie, of Aspen, Fonah, Pitlochry, was an employee of the Scottish ambulance service. I have written to my right hon. Friend the Minister many times about the problems that Mrs. MacKenzie faced in her employment. She believes that her dismissal from the Scottish ambulance service was the result of a false picture of her as an employee, created by the shop steward and possibly others in the way in which they destroyed records.

Mrs. MacKenzie believes that several factors caused the problem. The first was that she would not become a member of the relevant trade union for the ambulance service. She also refused to take an ambulance on shopping trips—not shopping trips to pick up just a roll or a sandwich, but trips to buy five or six bags full of weekly shopping. The ambulance that she was responsible for was removed from the station and used for such trips. Written regulations in her contract of employment forbade that practice.

My constituent's refusal to accept such practices led to difficulties over injections to protect her against hepatitis B. She claims that some employees of the Scottish ambulance service criminally destroyed prescribed drugs that were sent to the ambulance station at Pitlochry for use by Mrs. MacKenzie to protect her against hepatitis B. She further claims that an employee of the Scottish ambulance service criminally altered or falsified the record and log books that were required to be kept in connection with immunisation records.

Mrs. MacKenzie also claims that an employee of the Scottish ambulance service criminally destroyed faxes, sent to the head office of the service, in which she repeatedly requested that the prescribed drugs held in her name should be released from the refrigerator so that she could take them to her GP for immunisation. She stresses that the Scottish ambulance service is a record-keeping organisation. It now admits that the second and third doses were sent to Pitlochry ambulance station. As they were not returned to the occupational health service, it was presumed that she had been in receipt—in other words, that she had had the injections. Presumption, as she says, is not in accordance with its status as a record-keeping organisation.

My constituent claims to have evidence that the logs and records were falsified to make her appear to be a bad timekeeper. She holds copies of faxes disproving that allegation. Mr. Duffy, an ambulance man at Pitlochry of 21 years' service, also confirms that that is not correct. He gave evidence at a disciplinary hearing at the Scottish ambulance service headquarters in Edinburgh. When asked if there was a troublemaker at Pitlochry station, Mr. Duffy replied that he thought that there was—someone who he felt held too much influence in the station. He thought that the wrong person had been dismissed.

He went on to say that the individual in question was a shop steward at the station. Mr. Alan Jamieson, who seemed to have a great deal of influence in that other staff would follow his lead. When asked whether he had been threatened before the tribunal, Mr. Duffy said that he had not, but when he was asked whether he had been told to be careful about what he said at the hearing, he said that Mr. Delpippo, the senior officer in Perth, had told him to watch what he said.

Mrs. MacKenzie says that the whole matter is being swept under the carpet by the Scottish ambulance service and that the Health and Safety Executive has been passing incorrect information to Ministers, who have therefore been misled. Mrs. MacKenzie sets out her concerns in her letters to me, as her Member of Parliament, of 4 February 1996, 28 March 1996, 8 April 1996, 1 May 1996 and 2 June 1996, copies of which have been sent to my right hon. Friend the Minister. She states that there are known to be 350,000,000 carriers of hepatitis B in the world, that it is spread not only through blood, but can be contracted through saliva and other body fluids, and that hepatitis B is more dangerous than hepatitis A.

Mrs. MacKenzie maintains that the Health and Safety Executive states in a letter to me, as her Member of Parliament, that it found no evidence that she was required to undertake work that would have necessitated immunisation against hepatitis B—emergency 999 calls. She asserts that that is not true and that the Health and Safety Executive never asked her what evidence she could provide. She claims that the evidence is recorded and that the ambulance man of 21 years' service would verify that.

Mrs. MacKenzie claims that the Health and Safety Executive refused to implement proceedings where she could prove breaches of the Health and Safety at Work etc. Act 1974. She claims that they included falsifying records and criminal malicious intent. She suggests that the Health and Safety Executive could question the long-serving ambulance man or investigate the trail of injectable material and find out where and how it disappeared, bearing in mind that she was in the service for 15 months after the material was sent to the station. I remind my right hon. Friend that Mrs. MacKenzie received her first injection during her training course.

The Health and Safety Executive has made more of an issue of the changed rules that the Scottish ambulance service has implemented since her problems arose than the events and circumstances involved in her case. Mrs. MacKenzie states that changes to procedures are of no interest to her and bear no relevance to what she calls "a previous criminal act". She asks why the Health and Safety Executive is satisfied with changes that have now been made, when she believes that she can prove criminal, malicious intent that exposed herself, her husband and her two children to hepatitis B.

Mrs. MacKenzie believes that the Scottish ambulance service purposely misinformed Ministers. For example, the chief executive of the Scottish ambulance service stated that Mrs. MacKenzie was employed as a patient transport ambulance care assistant and that immunisation against hepatitis B was not required for such staff, but that it was offered as it saved time when staff moved to emergency duties where such immunisation was required. Mrs. MacKenzie claims that that is simply not true, and that when she first joined the ambulance service she was given the first of three injections against hepatitis B during her first week at training school. She states that it was also her personal desire to be immunised, and claims that the Scottish ambulance service had a duty of care to ensure completion of her course of injections and to act on her verbal, written and faxed communications stating that she had not received her last injection.

Mrs. MacKenzie was sent on 999 emergency cases, and records at Pitlochry and the local hospital on her attendance are there for anyone to see. In the course of those duties, she received staining of blood on her skin and clothes, which is, of course, the reason why staff are immunised against hepatitis B. She attended those 999 calls because emergency personnel were not available.

Mrs. MacKenzie says that my right hon. Friend the Minister was told that the Scottish ambulance service records show that immunisation is given in three (loses over a period, that subsequent treatments were sent to the local ambulance station and that the Scottish ambulance service "presumed" that the procedure had been followed. She says that that is a blatant lie. The Scottish ambulance service was in receipt of a fax from her—she has a record of it from her fax machine—saying that she had not received her third immunisation dose despite her repeated requests. The fax was sent 15 months prior to the end of her service with the Scottish ambulance service and within the allocated time given for the completion of the three-part course of injections. She claims that the Scottish ambulance service has not told the Minister the truth by using the word "presumed".

Mrs. MacKenzie says that my right hon. Friend the Minister was told by the chief executive of the ambulance service that the settlement that she accepted at the industrial tribunal was the end of the matter and included aspects of her hepatitis B injections. She says that that is another lie. She provided me with a copy of the letter from her solicitor that clearly states that the industrial tribunal settlement is only connected to wrongful dismissal with regard to her contract of employment.

The letter, of which my right hon. Friend the Minister has had a copy, clearly states that the Scottish ambulance service's omission to provide her hepatitis B injection is a matter of "duty of care" owed to her by the service, and is based on "delict". She says that the matter settled at the tribunal is one of contract, which is entirely separate. She also says that the discharged papers that she signed at the tribunal did not prejudice her in any way with regard to matters concerning hepatitis B. She says that the letter that my right hon. Friend sent to me on 8 May states that she was not involved in any 999 calls, but that that is obviously a lie because the records show that she was. She says that he has not been told the truth and has been misled.

Mrs. MacKenzie says that my right hon. Friend the Minister should know that changed procedures bear no relevance to the criminal, malicious intent that was in force against her at the time. She says that he should also know that the destruction of prescribed drugs named for an individual is a criminal act, as is the refusal to provide prescribed drugs named for an individual. She claims that he has misled me by stating in his letter that the matter was settled at the industrial tribunal and that she accepted full and final settlement in respect of all claims under statute or common law arising out of her contract of employment and its termination. She says that that is simply not true. I repeat that Mrs. MacKenzie claims that her solicitor's letter clearly states that she settled only matters applicable to the contract of employment. She says further that the discharge she signed over the tribunal does not prejudice her in any way on the matters concerning the hepatitis B injections.

Mrs. MacKenzie says that my right hon. Friend has refused to acknowledge serious wrongdoings by the Scottish ambulance service and that attempts have been made to cover up and to mislead my right hon. Friend, and that the Scottish ambulance service is responsible for that. She asks that her claim, that proven criminal intent and incorrect procedures have resulted in a serious breach of the health and safety at work Acts, be acknowledged.

She also asks that an independent inquiry should be set up to examine and determine the evidence, which she claims is all there, and that the Health and Safety Executive question and investigate all the parties. It is not suitable or correct that the matter should rest with the explanations that have been provided by the Scottish ambulance service. She says that the Health and Safety Executive has now accepted that changed procedures are the answer, but she says that it is sweeping everything under the carpet; the solution to her complaints about criminal and malicious intent in the matter of her hepatitis B injections must be examined.

Mrs. MacKenzie claims that she is able to prove a clear breach of the health and safety at work Acts and criminal and malicious intent in those responsible for the matters. She asks that my right hon. Friend initiate an independent inquiry and that the Health and Safety Executive bring matters forward for prosecution. She further says that there should be a police or criminal inquiry.

In conclusion, I have in my possession a reference received from the Pitlochry festival theatre on behalf of Mrs. MacKenzie and I will give a copy to my right hon. Friend after I have finished speaking. The reference shows that she was employed by the theatre and that the managers think highly of her. It says: I would strongly recommend her for any job she would wish to choose". That is only part of what is said in the recommendation from the Pitlochry festival theatre. I know the theatre managers well and I know that they would not write that if they did not believe it.

The allegations and charges being made by Mrs. MacKenzie are serious. The only way to resolve the matter is by having it thoroughly investigated by someone independent so that the truth can come out.

9.42 pm
The Minister of State, Scottish Office (Lord James Douglas-Hamilton)

I congratulate my hon. Friend the Member for North Tayside (Mr. Walker) on his success in obtaining the debate. In response to his call for an inquiry, I may say that the Health and Safety Executive has investigated the matters fully on the basis of the evidence made available to it. The Health and Safety Executive can act only on the information it has and if Mrs. MacKenzie has further evidence that she has not yet made available, I respectfully suggest that she does so. My hon. Friend referred to the allegations of criminal activity, and again, if Mrs. MacKenzie has not already submitted all the relevant information to the procurator fiscal, I recommend that she does so.

I know that my hon. Friend has been exercised about this matter and we corresponded earlier in the year. I intend to take a few minutes to explain the role and function of the Scottish Ambulance Service NHS trust and how it goes about discharging its responsibilities and to demonstrate its treatment of Mrs. MacKenzie's case.

Established on 1 April 1995, the Scottish Ambulance Service NHS trust provides a 24-hour national accident and emergency service for the people of Scotland. It also provides an essential non-emergency patient transport service conveying patients to and from NHS trust hospitals, clinics and day centres across the length and breadth of the country. Consuming more than £74 million of revenue per year, the trust employs around 2,900 staff, of whom about 2,500 are operational ambulance staff, officers and control personnel. Collectively, those staff will respond to nearly 500,000 emergency and urgent calls each year and make 2.5 million non-emergency patient journeys. In more than 90 per cent. of emergency cases, the ambulance will be in attendance within the appropriate target response time.

The role of accident and emergency crews has developed dramatically in recent years. In the past, their prime function was to "scoop and run", the priority being to transport the patient to a hospital as quickly as possible. For some patients the time taken to reach the hospital was simply not quick enough, and it was recognised that what was essential to the chain of survival of a patient was how long it took the first response to reach the scene of the accident or emergency. For many, that first response was not a doctor or other clinician, but an ambulance man, and it was, as a result, acknowledged that the skills and capabilities of ambulance men and women needed to be developed.

The Royal College of Surgeons and the Royal College of Physicians, along with senior consultants in accident and emergency and in other specialties, were engaged in determining what range of skills and training should be given to ambulance personnel. Representatives of the colleges and of the key specialities involved with accidents and emergencies continue to play a significant role to this day as members of the services professional advisory group, routinely influencing the scope and content of the professional training given to front-line personnel. While the speed of transfer to hospital remains of course a priority, the product of that commitment is that, nowadays, ambulance men and women are highly skilled professionals who are capable of dealing with a wide variety of medical and traumatic emergencies on which they may be called to attend.

Despite the demanding and often very stressful nature of the work, each year sees many thousands of men and women applying for a small number of positions. However, the vast majority of entrants into the ambulance service will start initially as ambulance care assistants and will, following basic training, work on non-accident and emergency services. Even at that level there are more than 100 applicants for every vacancy. The trust is generally regarded as a good employer. Within 18 months of having achieved trust status, more than 85 per cent. of staff opted voluntarily for the locally negotiated trust terms and conditions of service, which are uniquely supported by all the major trade unions involved.

The trust's newly opened national training college provides a consistently high standard of instruction for staff at all levels, from ambulance care assistants through to ambulance technicians and paramedics, up to and including tutor training of instructors for ambulance training centres in England and Wales. Of course, being a good employer goes beyond induction and training and kitting out—it involves looking after employees on an on-going basis, being alert to the stresses and dangers facing ambulance personnel and taking action to eliminate those risks, or at least to minimise them, wherever possible.

That action can often be taken at what may be described as the "macro" level. For example, my hon. Friend may care to know that the ambulance service is actively involved in a working group that I set up to investigate and report into the risks and dangers to front-line emergency personnel and how these might best be mitigated across all the emergency services so as to safeguard personnel against assault. Such action can also take the form of the counselling services that the trust provides for personnel who have had to attend on major incidents and who have themselves perhaps been traumatised as a result; or it can be in the very specific and tangible measures taken to immunise personnel against the risk of infection from patients with whom they come into contact.

It is as a good employer and in recognition of the fact that emergency ambulance crews are at risk of coming into contact with members of the public who carry infectious diseases that the trust's policy is to insist upon the mandatory vaccination of all accident and emergency ambulance staff. I would, at this point, make it absolutely clear to my hon. Friend that, because medical advice is that there is no identifiable risk, hepatitis B immunisation is not required for non-emergency patient transport staff, including ambulance care assistants. Nevertheless, as a good employer, the trust provides immunisation to all those non-emergency personnel who wish to avail themselves of the opportunity to be immunised.

My hon. Friend's constituent, Mrs. Susan MacKenzie, joined the Scottish ambulance service as a trainee part-time ambulance care assistant in February 1993. Before leaving the ambulance service training school, she elected to receive the first of a series of three injections for immunisation against hepatitis B.

Mrs. MacKenzie was subsequently employed as a part-time ambulance care assistant located at the Pitlochry ambulance station. In accordance with the protocols that existed at that time, the second and third doses were sent by the Scottish Ambulance Service occupational health service to Pitlochry ambulance station for Mrs. MacKenzie to have administered by her local general practitioner.

There is no question about the matter of the second dose, which Mrs. MacKenzie had administered to her by her local GP. Nor at any time has the Scottish Ambulance Service NHS trust taken issue with the claim made by Mrs. Mackenzie that the third dose of the vaccine was not passed on to her. Indeed, following her subsequent departure from the service, under the full and final settlement that she and her legal advisers accepted and signed, all issues raised by Mrs. Mackenzie were considered closed. As a result, there was no requirement to hold the planned industrial tribunal.

Nevertheless, notwithstanding the settlement, the chief executive of the Scottish ambulance service acknowledged that there was a deficiency in the rigour with which the occupational health service procedures had been operated at Pitlochry ambulance station, and he has, in co-operation and consultation with the Health and Safety Executive, taken steps to prevent any future recurrence of such a situation, while at the same time re-emphasising the lack of any identifiable risk of hepatitis B to non-emergency patient transport staff such as Mrs. MacKenzie.

Indeed, it was only subsequent to Mrs. MacKenzie's dismissal that the matter of her having failed to receive the third dose of vaccine was pursued by her in a manner that enabled the claims to be properly investigated by the senior management of the trust.

In case there remains any doubt about the clinical basis for the Scottish ambulance service's policy of mandatory immunisation against hepatitis B for accident and emergency ambulance staff, and the fact that immunisation for non-emergency personnel is optional, I shall quote from the established guidance on the matter, the book "Immunisation against Infectious Diseases", published jointly by all United Kingdom Health Departments. It states: The incidence of infection is not apparently greater than in the population as a whole for members of the police, ambulance, fire and rescue services. Nevertheless, there may be individuals within these occupations who are at higher risk and who should be considered for immunisation. Such a selection has to be decided locally by the Occupational Health Service or as a result of appropriate medical advice following the necessary risk assessment. As we have heard, it is the policy of the ambulance service that immunisation against hepatitis B is mandatory for all staff on accident and emergency service duties. There is a theoretical risk that such staff may be exposed to the virus through cuts or abrasions that they could sustain when dealing, for example, with a patient bleeding heavily in a difficult environment such as a car crash. The use of gloves and safe working practices keep such risks to a minimum, but immunisation is considered an appropriate further safeguard.

I would also suggest that the particular incident should be kept in perspective. I mention to my hon. Friend the fact that there was and is no requirement for the service to provide immunisation against hepatitis B for personnel involved in the provision of patient transport services. That reflects a clinical recognition of the reality that the risks to such personnel of contracting the hepatitis B virus are considered to be so small as to be incalculable.

None the less, the ambulance service takes the most cautious view possible, and goes far beyond reasonable minimum precautions in offering non-emergency staff immunisation. I am very much aware of the fact that it is the view of my hon. Friend's constituent that the failure to provide her with the third injection was in effect a criminal act, and one which warranted the consideration of the procurator fiscal.

However, I remind my hon. Friend that that point was considered carefully by the Health and Safety Executive. Indeed, as the director general of the Health and Safety Executive stated clearly in the letter that my hon. Friend sent to me on 29 April: there is no evidence to support the assertion that the Scottish Ambulance Service failed to meet its responsibilities under Health and Safety Legislation in respect of Mrs. Mackenzie and therefore no case which could be put to the Procurator Fiscal. The Scottish Ambulance Service NHS trust has accepted that, for whatever reason, Mrs. MacKenzie did not receive the third and final dose of vaccine to enable her to complete her course of immunisation against hepatitis B. Following consultation with the Health and Safety Executive, the trust has improved its recording procedures to prevent any future recurrence of such a situation. On the matter of all claims arising out of her contract of employment, I would remind my hon. Friend the Member for North Tayside that, following her departure from the service and her subsequent action against the trust, she and her legal advisers agreed to accept a sum of £2,500 in full and final settlement.

On Mrs. MacKenzie's claims regarding the course of hepatitis B immunisation, this matter was fully investigated by the Health and Safety Executive—the competent authority—which found that the Scottish ambulance service had not breached its duty of care. The Health and Safety Executive can, of course, only act on the evidence available. If Mrs. MacKenzie has evidence to support her assertions which she has not previously made available to the Health and Safety Executive, I strongly recommend that she does so.

Mr. Walker

The basis of Mrs. MacKenzie's case—which I probably did not put well enough—is first, that she disputes that she agreed to a full and final settlement and, secondly, that she attended emergencies, as the records at Pitlochry show. It is all very well to say that people in her job should not attend emergencies, but she did attend them and was exposed to the risks of hepatitis B. The service was not protecting her against that because she did not receive the third injection.

Lord James Douglas-Hamilton

It is standard practice in the ambulance service that, if no accident and emergency ambulance is available to respond to a 999 call, any non-emergency crew available will attend, pending the arrival of an accident and emergency unit. Training for non-emergency patient transport staff includes basic first aid and resuscitation. Such skills—whether provided by an ambulance care assistant or a member of the general public—can obviously save lives. On that basis, it would not be acceptable for the service to withhold any help that it could make available as soon as possible.

I understand that Mrs. MacKenzie was not required to perform any duties or procedures for which she was not suitably trained and equipped. I note what my hon. Friend the Member for North Tayside says about the final settlement. The information that I have received is different, but this is a legal matter and Mrs. MacKenzie is free to consult her lawyer on that point.

In concluding, I would like to take the opportunity to inform my hon. Friend the Member for North Tayside about the nature of the services provided by the Scottish Ambulance Service NHS trust. The trust provides three main services to the people of Scotland—the accident and emergency service, the non-emergency patient transport service and the patient air transport service, referred to as the air ambulance service.

The accident and emergency ambulance service is the one we see in action every day on the streets of our cities, towns and villages. This is the service which responds to 999 calls made by the public. It also responds to calls made where a doctor, dentist or midwife is already attending a patient and requests an ambulance to take them to hospital within an agreed time. These calls— known as urgent calls—form a major part of the demand on the accident and emergency service, although many people are not aware of this activity.

The accident and emergency service consumes by far the largest share of the considerable resources devoted to the service. By its very nature, demand for the service is largely unpredictable and a number of strategies have been adopted to optimise the use of resources. These include sector ranging, whereby ambulances, rather than operating from fixed ambulance stations as in the past, take up position at predetermined locations.

The changing demography of our towns and cities, as well as the development of the roads, can sometimes mean that ambulance stations which were ideally situated 20 years ago are now further than desirable from the populations they serve. Sector ranging is one solution to this, while another, of course, is the construction of new ambulance stations. There is currently an on-going programme of upgrading and replacing ambulance stations in Scotland and I shall, incidentally, be travelling to Glasgow tomorrow morning to open a new station at Clydebank on the west side of the city.

The special difficulties in urban areas also call for innovative solutions. In Glasgow, paramedics on motor cycles bring emergency help when a conventional ambulance cannot reach the patient. In other cities, paramedic response units also operate. They are designed to provide an emergency response as quickly as possible. We are determined to have the best ambulance service in the world.

Scotland has the only fully integrated air ambulance service in the United Kingdom and by far the largest, operating four fixed-wing aircraft and two helicopters in addition to the back-up provided by the Ministry of Defence and Coastguard services.

I congratulate my hon. Friend the Member for North Tayside once more on securing this debate. I hope that I have managed to address his concerns and to reassure him that these matters have been dealt with in a proper and professional manner by the Scottish Ambulance Service NHS trust.

If my hon. Friend's constituent has further evidence, it should be made available to the Health and Safety Executive, and if she has evidence of criminal activity, it should be reported to the procurator fiscal. With that, I hope that I have fully covered the subject.

Question put and agreed to.

Adjourned accordingly at Ten o'clock.