§ Mr. Richard Livsey (Brecon and Radnorshire)
I am confronted with every middle-aged Member's nightmare: my reading glasses went missing in the past hour and I am unable to read my speech. However, the Library has come to my rescue, and South and East Wales ambulance NHS trust will be put under the magnifying glass. It is especially appropriate as we are talking about the national health service and one might mention eye tests in passing. My eyesight is quite good and only requires a magnification of 1 or 1½, so I shall have a go and see how I get on.
I want to talk about the performance of the South and East Wales ambulance NHS trust in relation to Powys. It is not a tale that it should be proud of.
Wales is often unfairly referred to when drawing parallels with the size of a problem—rather larger than this magnifying glass, of course. Many disasters on the map of the world are said to take place in an area the size of Wales. In fact, Wales is much larger than people who live outside it—or people who live in certain corners of it—may realise. I do not know whether the House realises it, but the county of Powys is about 135 miles long. If it were placed lengthwise on the south of England it would stretch from the Severn bridge to Chiswick flyover. Given the number of constituencies that it would encompass, it is a massive area of territory.
The story of Powys in the past five years—under a different Administration—has not been a happy one. We have lost control of several services. Our fire service, which we used to control from Powys, is now operational from Carmarthen, as is our health authority. Effectively, 42 employees used to run Powys health authority from Bronllys in my constituency; almost all of that operation has closed down and now operates from Carmarthen. We were told last week that the Development Board for Rural Wales may be subsumed into the Welsh Development Agency; that may be the result of decision making in Cardiff.
Perhaps the most bizarre union took place at the time when the Conservative Government were manufacturing trusts at the rate of almost one a minute. There were effectively competitions to produce trusts. Some of the managers in Powys got empire building and when they moved to Cardiff they set their sights retrospectively on Powys and decided that they would build the South and East Wales ambulance NHS trust, a jumbo-sized ambulance trust, covering the huge area from Penarth in the south to within 10 miles of Wrexham in the north.
That decision set in train many events. We are distressed about what has happened. I shall do my best to describe some of the problems that we have witnessed in the past three or four years.
The ambulance trust was as dire as we had expected. It started in headquarters in Cardiff and moved to brand new headquarters in Pontypool—a state-of-the-art complex of the type that empire builders are encouraged to indulge in.
Most country people in Powys are blessed with a great deal of common sense, and forecast more or less immediately what would happen as a result of the creation of that jumbo-sized trust. The inevitable has occurred—an overspend, estimated to be £1.5 million to £2 million, resulting from the amalgamations.
313 Savings were then needed, and the middle management operating in Powys were sacked to save money. The middle management who operated Powys ambulance services so successfully in the 1980s and early 1990s did not run at a loss in any financial year. They were competent managers and ran the service with probity.
The trust became short of facilities, especially ambulances. A commitment had been made by contract with Dyfed Powys health authority that a certain number of ambulances would work in Powys. However, it was not beyond the imagination of SEWAT to transfer ambulances from the Crickhowell ambulance station in Powys to Cardiff to ferry patients from Cardiff royal infirmary to the university hospital of Wales, because of a shortage of ambulances. That had a knock-on, kickback effect into Powys, where extra cover had to be provided from Llandrindod to Brecon and Bronllys, which were providing cover for Crickhowell. I am told by operatives in Crickhowell that they spent most of their time working in Gwent, but Dyfed Powys health authority appears to being paying for all that.
This resulted eventually in Dyfed Powys health authority threatening SEWAT that it would terminate its contract forthwith because it was not providing the necessary service. The lively and intelligent people of Powys realised what was going on all along; 15,000 of them signed a petition in February, saying that they wanted their ambulance service back. The petition was stretchered up the steps of the Welsh Office in Cardiff. All 15,000 signatories were residents of Powys, who demanded a repatriation of their ambulance service.
My hon. Friend the Member for Montgomeryshire (Mr. Öpik) and I took a further 16,000-name petition in early June—collected in conjunction with the Shropshire Star—concerning the closure of a communications centre in Newtown, to the Secretary of State at Gwydyr house in Whitehall. Altogether, therefore, 31,000 people in Powys have expressed on petitions their dissatisfaction with the service.
In the meantime, there has been an horrendous litany of cases of poor communications between Pontypool, where the centre is, and Powys. Mistakes have been made; place names have been confused. Perhaps the worst example that I can give is that an ambulance that was supposed to arrive in Bala road in Llanfyllin arrived in Bala in Gwynedd instead. That type of thing appears to have been happening because the people in Pontypool do not know the geography of Powys. Eventually, they came to their senses and imported three residents of Powys to operate the communications centre in Pontypool.
Perhaps the worst feature, however, is that for some reason it was decided to close the communications centre of SEWAT in Newtown. I regard that as an act of vandalism, because the Newtown centre was working extremely well and knew all parts of Powys. There was no delay in getting ambulances to the right place within the specified 21-minute turnaround time. The problem is that it was decided to close it down. However, not only was it closed down but equipment worth some £80,000 was removed from the centre and it will take some doing to get the communications centre put back in Newtown. We find that extraordinary, and it culminated in a disjointed communications system.
314 In late February, I went to the hospital in Llandrindod and was confronted with a doctor, a nurse and an upset lady in a bed who had been waiting for two days to go to Hereford for an operation because no ambulance was available to take her from Llandrindod to Hereford. The bed had been booked in Hereford hospital and the surgeon was waiting to perform the operation, but there was no ambulance. After three hours on the third day, no ambulance had yet shown up. Understandably, she was in some pain and needed the operation urgently.
What does the Minister intend to do about the re-configuration of ambulance services in Wales? I have a dossier of comments from every GP practice in my constituency about the ambulance service in Powys. I shall give just one example of the sort of thing that has been happening. In a letter to the chief executive of SEWAT, Mr. Morris from Brecon in my constituency said:Between midnight and I am on the morning of Saturday 14th June Doctor Diane Davies made a 999 call to summon an ambulance to 26, Pendre Close, Brecon, Powys. My mother, Helena Mary Morris was very ill and needed to be taken to hospital.After some twenty minutes the ambulance had failed to arrive so Doctor Davies rang Brecon War Memorial Hospital where the ambulance is based. It emerged that the crew were completely unaware that they were needed.They were less than a mile away from the patient. The letter went on:They then immediately came to the assistance of my mother.Despite the efforts of Doctor Davies and the ambulance crew my mother passed away.I am very angry at what is such conspicuous incompetence on your organisation's part and I require an immediate explanation from you.An explanation has been given, but it certainly does not match my constituent's description of what happened.
§ Mr. Lembit Öpik (Montgomeryshire)
Does my hon. Friend agree that that case underlines the gravity of the problem? SEWAT's problems do not just lead to inconvenience; they may be endangering the lives of people in Powys and they will continue to do so until we have an absolute assurance that they will be resolved.
§ Mr. Livsey
I agree very much with what my hon. Friend said.
Dr. Harvey of Talgarth wrote to the Dyfed local management committee of the trust outlining the problems that had been experienced. He said:Though we were informed that there was to be a change"—in the operation of the ambulance service as a result of the removal of the control centre—we actually were given one week's notice of the actual date of change.We had severe difficulty getting information from headquarters as all calls were diverted to an answer machine and we rarely received a reply.He was referring to the doctor's answering service run by SEWAT. The GP practice in Knighton has given up on SEWAT, as have many GP practices in Powys, and is using a service operating out of Wolverhampton. Dr. Harvey goes on to say:We were given five days notice that our original radios were no longer of any use and had to be replaced at the cost of £900.315On the first night (27 March) we know for a fact that a patient with abdominal pain had to wait two hours before the doctor received the message (this was a test call by one of our lady doctors' husband to see what their response time was!)I have pages and pages of that sort of information if the Minister would like to receive it from me. It covers not just February and March but April and May. We should like to know, first, that Powys ambulance services are detached from SEWAT where it has been proven beyond all reasonable doubt that SEWAT is far too large and unwieldy, and incapable of managing the service in Powys effectively; and, secondly, that ambulance services in Powys will be returned to management in Powys, if necessary as a devolved division of Powys NHS trust. Thirdly, will the Minister confirm that American consultants are being used to advise the Welsh Office about ambulance services in Wales and that there are plans for either three ambulance services or one service for the whole of Wales? Will the Minister guarantee to the people of Powys that their ambulance service will be administered from within Powys?
The maxim of all this must be: local knowledge saves lives. Nothing less will do.
§ The Parliamentary Under-Secretary of State for Wales (Mr. Win Griffiths)
I am grateful that the hon. Gentleman has raised this important issue as it gives me an opportunity to respond to any concerns the residents of Powys might have about these vital services.
The Government regard ambulance provision as an integral and important part of the health service, providing a front-line, life-saving service to the people of Wales. It is appropriate at the outset to pay tribute to the ambulance men and women, control staff and all the other staff and management who play such an important role in this relatively small but key part of the national health service. I am only too aware of the increasing pressures that the ambulance service must deal with daily through increased numbers of emergency and urgent calls. In the face of the increasing work-load, the dedication of all those staff has been demonstrated time and again, and we all owe them a debt of gratitude.
The South and East Wales ambulance NHS trust—or SEWAT, as it is better know—is by far the largest provider of ambulance services in Wales, serving a population of more than 1 million people. Those services are provided throughout the unitary authority areas of Powys, Blaenau Gwent, Monmouthshire, Torfaen, Caerphilly, Newport, Cardiff and the Vale of Glamorgan. Within that area, Powys accounts for some 10 per cent. of the trust's catchment population, with 122,000 residents living within a vast area of over 2,000 sq miles. If I may put that into context, the population of Cardiff currently stands at just over 300,000 within an area of just 54 sq miles. Clearly, the county of Powys needs special attention to cover such vast distances and address other problems associated with its rurality. Having been brought up in Powys, I am aware of all those matters. Indeed, I still have family in the town of Brecon, to which the hon. Gentleman referred when bringing a sad case to our attention.
316 SEWAT was formed on 1 April 1993 by the amalgamation of three county ambulance services. Since it was formed, I recognise that the trust has made efforts to improve performance standards across all the areas it serves. Despite increasing numbers of emergency calls, the trust has improved its performance against the existing standards for ambulance response times in Powys. Those standards dictate that for 95 per cent. of emergency calls an ambulance must arrive at the scene of an incident within 21 minutes. In the year to 31 March 1992, a total of 4,146 emergency calls were dealt with by the former provider of ambulance services for the area of the Powys health authority, with an 83 per cent. response within 21 minutes. By comparison, in the year to 31 March 1997, calls had increased by almost 10 per cent. to 4,424 and, despite this significant increase, the trust managed to improve its response times for the 21-minute standard to just over 90 per cent. Although that falls short of national standards in Wales and the trust is currently facing difficulties in reaching the required performance targets, I am sure that hon. Members will agree that in Powys the South and East Wales ambulance trust has made real progress since it was first established.
As hon. Members know, however, SEWAT has had more than its fair share of problems—poor management, loose and unacceptable financial control, substandard services in some areas and practices that have, on occasion, fallen well below the standards that we would all expect from a public body. We have made it clear to the SEWAT board that we expect things to change and, I am pleased to say, there is some evidence that that is happening.
Financially, the trust seems to be returning to a firmer footing and in a number of other areas concerned with the real business of the trust—I mean the services that it provides—the board is taking action to put right issues that have dogged its rather unfortunate history—none of which, I am pleased to say, this Government have been associated with.
I know that the hon. Member for Brecon and Radnorshire and other hon. Members have been concerned about SEWAT's new command and control centre, which was developed as part of the trust's programme to upgrade and improve the facilities and services that it provides. In 1994, each of the three areas served by the trust had in place its own control centre. Those were based at Cardiff, Newtown and Caerleon and although they were still operable, as a result of lack of investment the trust had inherited aging and unreliable technology that was in urgent need of replacement. In the case of the then Gwent and South Glamorgan control centres the equipment was more than 10 years old, and in the case of Powys the equipment was due for replacement the following year.
The trust examined all possible options for replacing the equipment, including simply purchasing new equipment for each site. It concluded that the most appropriate route to follow was centralisation on a single site at Mamhilad. One of the major benefits to arise from centralisation was the elimination of the fragmentation of services within the trust. At the time, each ambulance division was acting in isolation from the others, with the result that cross-boundary co-operation was poor.
317 Such a situation was intolerable in a single trust. The buildings housing the previous control centres were in a poor state of repair and would have required major structural work to bring them up to their former standard. The trust considered that the resources would be better utilised to provide additional medical equipment and to train more ambulance staff.
Although there are benefits associated with the centralisation of control centre functions, there have been a number of significant teething problems, some of which have been raised in correspondence that I have received from the hon. Member for Brecon and Radnorshire and from the hon. Member for Montgomeryshire (Mr. Öpik), who I see is in his place.
The decision of some staff at the last minute not to relocate from the Powys control centre to the new centre at Pontypool initially led to staff shortages and, coupled with technical difficulties, led to an increased number of problems for the trust. Those have now been addressed, following the recruitment of additional staff and the correction of difficulties with the technical equipment.
A number of operational measures have been introduced to help to resolve the trust's problems in relation to command and control. One of the most significant problems in dealing with the Powys area in the early stages of the implementation of the new control centre was the lack of geographical knowledge of the area, again partly due to the reluctance of staff to relocate. That led to a small number of calls being directed to the wrong location and caused some confusion and distress, not only for patients and their relatives, but for the ambulance crews who worked in those areas.
The trust has addressed the problem by ensuring that emergency calls from each of the three health authority areas served by the trust are handled separately. In addition, calls from GPs are handled by separate staff, as are calls relating to patient transport services.
Another major step that the trust has recently taken to eliminate the confusion caused by the lack of geographical knowledge of the control room staff is the purchase of a geographical information system. This allows staff to see on a single map the exact location of the caller and all the ambulances in that area, and to decide which ambulance should be assigned to the call and the length of time that it will take to arrive at the incident.
We should not forget the vital role played by the ambulance crews themselves. Their invaluable local knowledge allows them to reach the patient by taking the most appropriate route, and the same knowledge allows the patient to be transported to hospital, if necessary, by the quickest and safest route.
The importance that the trust places on ensuring that those and other problems are dealt with swiftly in Powys is clearly demonstrated by its willingness to work with other local health providers. It has established a development group which is chaired by the trust's own director of operations and includes representatives of the Dyfed Powys health authority, the local medical committee and the Powys Healthcare Trust.
The group seeks to address concerns over performance measures, standards and protocols for the ambulance service in the Powys area. It is also a useful tool for the 318 trust to rebuild relationships with those organisations after the recent difficulties in the Powys area. I firmly believe that the only way in which health services of any kind can be provided effectively is through co-operation between all health care agencies, and I applaud the trust's efforts in that respect.
Welsh Office officials have been, and remain, in close touch with the chairman and chief executive of SEWAT and, having seen the new facilities, were very impressed with the technology and systems employed and the capability of the staff. I have been informed by the chief executive of the trust that he would be pleased to welcome the hon. Gentleman to the trust headquarters to view the new command and control centre and to discuss any issues that he might wish to raise, and I recommend that he take up the offer. I am aware that the hon. Member for Montgomeryshire is taking advantage of a similar offer and will be visiting the trust on 12 August.
Performance standards are an important indicator of how well an ambulance trust is providing services to the population. However, the current standards tell us only how quickly an ambulance arrives at the scene of an incident; they do not give us details of the usefulness of the ambulance upon arrival, or the actual outcome for the patient following the intervention of ambulance personnel. For that reason, the Government are examining the financial and operational consequences of introducing new criteria-based performance standards in Wales.
The new standards would be based around the need for ambulance services to categorise calls according to urgency and medical need. The highest priority would be reserved for immediately life-threatening conditions such as a heart attack. We hope that that will help us to provide an even better service.
Because of their uniqueness, I accept that such new standards would mean significant challenges for the trust in the Powys area. However, I would look to the health authority and the trust to rise to the challenge and meet any exacting new standards that we decide to introduce.
§ Mr. Livsey
In the light of his speech, will the Minister tell us whether he is satisfied with SEWAT's performance, or are we due for another review of the configuration of ambulance services in Wales? Is there shortly to be a new configuration?
§ Mr. Griffiths
I am not satisfied with the way in which SEWAT has been operating. Although it has greatly improved, from as late as May this year I have a three-page catalogue of complaints about the way in which the service operated. Those complaints come from hon. Members, people in the health service and even Machynlleth town council. Many bodies have complained. I can only apologise for what has happened and express my regrets about cases in which there were serious outcomes because of the failures of the trust to act properly.
More paramedics are being trained. There are now 37, and there will be a further four by the end of October. I look forward to significant improvements.
With regard to the review of the ambulance service configuration, it was widely reported last Friday that the Welsh ambulance policy advisory group had recommended a new configuration for ambulance services in Wales. There have been reports in the press of either 319 one service or three services. It is too early for me to respond to the report. The proposals are undoubtedly radical, and I will want to consider them and have further discussions. I would welcome further observations from Opposition Members or my hon. Friends about the reconfiguration of ambulance services in Wales. An announcement will be made in the not-too-distant future.
I repeat that I am only too well aware of the problems facing SEWAT in the Powys area and the major steps being taken by the trust to address those problems. I am 320 informed that the earlier difficulties experienced with the introduction of the new command and control centre are being overcome. I expect the people of Powys to have an ambulance service that fully meets their needs and of which they can be proud. Notwithstanding that, I appreciate the need to reshape the ambulance service in Wales so that all people can receive a better service.
§ It being Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.
§ Sitting suspended, pursuant to Standing Order No. 10 (Wednesday sittings), till half-past Two o'clock.