§ Mr. Lawrie Quinn (Scarborough and Whitby)
I am grateful that my topic has been selected for debate this afternoon, as it is extremely important to the people of Scarborough and Whitby, the people of North Yorkshire and our near neighbours.
I congratulate the Minister of State for Public Health, my hon. Friend the Member for Dulwich and West Norwood (Ms Jowell), on her recent appointment, and I wish her well in her endeavours on behalf of my constituents. Unfortunately, we do not have a full complement of Members in the House at present—perhaps because the debate has been called early. I wrote to those hon. Members who have an interest in such matters advising them of the debate, and I look forward to seeing them here before I conclude.
On 14 November 1996, Channel 4 screened an edition of the "Dispatches" programme that made a series of allegations about the North Yorkshire ambulance trust's operational effectiveness and management style. The programme initiated much local concern in North Yorkshire, and featured heavily in the national media. Following those allegations, the regional health office set up an independent review panel, chaired by Mrs. Anne Galbraith, on 15 November 1996. The long-awaited report was finally published on 3 June 1997.
Shortly after the publication of the report, the chair of the trust, Mr. Murray Naylor—who is, incidentally, a newly elected Conservative county councillor for the Rillington division—resigned from his post. A fortnight before the report was published, the chief executive, Mr. Michael King, retired on the grounds of ill health, at the relatively young age of 37. I must point out that I began my parliamentary career at the relatively ancient age of 40, and the Leader of the Opposition, the right hon. Member for Richmond, Yorks (Mr. Hague), recently assumed his responsibilities almost at the age at which Mr. King has retired.
I am also led to believe that some questions remain unanswered regarding Mr. King's illness. That is a serious concern for me and for those in the ambulance service who do not know what Mr. King's problem is. Front-line staff drew certain allegations to my attention and to that of the "Dispatches" programme producers. Some of those who blew the whistle about concerns within the trust were disciplined, and several people were dismissed for breaching their contracts of employment. Subsequent industrial tribunals upheld the management's decisions. As a result of the report's findings, I believe that the management's staff dismissal process looks unsafe, and I urge the Minister to consider that matter.
We may contrast the management's treatment of its staff with the tolerance that it showed to the former chief executive, Mr. King, during his long period of ill health. Many people in public service in North Yorkshire are deeply puzzled about that obvious inconsistency in the treatment of staff at different ends of the trust hierarchy. I believe that the matter should be re-examined in light of the review panel's findings.
818 The Galbraith report raised several key points. The national health service executive, Northern and Yorkshire region, states in a press release of 3 June:Performance standards were marginally over-stated but there was no evidence to substantiate the allegation of deliberate manipulationof figsures. It continued:The decision to procure a new command and control system, costing more than £650,000 was not fully tested against alternatives.The panel, quite rightly, questioned the appropriateness of the technology in view of the size of the trust. The procurement, installation and commissioning of the system are heavily criticised in the report.
The Galbraith report also decided that the trust's ratio of operational ambulance staff to trainers is inadequate. Although the trust fell into significant arrears with its paramedic re-certification programme in 1996, the panel found that the situation has improved. Galbraith also found that the organisation's management style had adversely affected the trust's operational effectiveness, and that was severely criticised in the report.
The trust took some remedial action following the James Dean incident, which was a sad incident in which a teenager died, but the issue remains of the responsiveness of the service to accident calls. The panel believed that there were some lessons to be learned, and I shall deal with them shortly.
The key point, as the panel decided, was a failure to separate income generation calls—those that concerned assistance for the veterinary service and dentistry—from emergency calls, which is why the service exists so as to help us. There seems to have been some confusion in the control room about the priorities to be given to incoming calls, which led to severe operational efficiency defects. The panel found that the problem had been remedied by the trust by early June.
I feel that there are some essential national lessons to be learned from this sorry tale. I know that the community in North Yorkshire expects that locally and nationally our health service should be managed efficiently, and should be there to deliver within the highest standards of public service.
As a former railway manager, I have carefully studied the Galbraith report and its findings. I have mounting concern about the internal management structure and style that was pervasive over the period leading up to the report being delivered. That structure and style failed to deliver an honest team-working spirit. I see a failure to establish what I regard as a no-blame culture within the workplace. I am concerned especially that there seem to be unresolved issues. I hope that my hon. Friend the Minister will consider these, perhaps in a later response.
I shall now inform the House of the sad events that occurred on the afternoon of Saturday 7 June. They took place in front of me during a journey that I was making between my constituency and York, within the constituency of the hon. Member for Ryedale (Mr. Greenway), who I see has now joined us in the Chamber. At about 3 pm, the radio news had just finished, and at that moment I could not really believe what I was seeing in front of me. I saw, about six vehicles ahead of my car, that a roof ladder had become detached from a pick-up truck and was lying almost horizontally across the opposite carriageway. It had the appearance of crop sprayer.
819 I saw a private car and a coach moving towards the ladder from the direction of York. The coach hit the ladder, and its windscreen was shattered. I pulled over and tried to help.
I discovered that the coach was occupied by a class of 12-year-olds from the Cavendish school, Hemel Hempstead. I am glad to report that no serious injuries resulted. I believe that that was due to the fact that all the children were wearing lap seatbelts, and because the driver was wearing sunglasses, which protected his eyes.
I made a 999 call on my mobile telephone at about six minutes past 3 o'clock. That was about four minutes after the accident had happened. The police attended within several minutes. I must commend them on their prompt action.
The problem, as I see it, was that the first ambulance arrived at about 25 minutes past 3, well beyond the standard response time that is expected. As I had studied the Galbraith report only a few days before the accident took place, and had been assured by subsequent press reports from the trust that major improvements had been made in meeting response times—I am on record locally in commending the work that has been done—I became concerned about response times. I feel that it is still a significant issue in north Yorkshire.
These events led me to call and write to Madam Speaker to ask for an Adjournment debate. I am grateful to her, because she must have thought that the matter deserved some attention.
I have some key questions for my hon. Friend the Minister. First, are the Government happy that the inquiry was wholly independent? As a test, I shall use an extract from a letter that was sent from my close and hon. Friend the Member for City of York (Mr. Bayley) to Mrs. Galbraith on 20 December 1996. I shall quote the paragraph about the independence of the inquiry. It reads:You will be aware that I have expressed concern about whether your inquiry will be independent. I understand that the North Yorkshire Ambulance Service was involved in 'headhunting' members of the inquiry team and in setting your initial terms of reference. I regard this as unsatisfactory but will judge your report on its merits before deciding whether to ask the Public Accounts Committee to investigate the allegations about the service.I would like feedback on that issue. I, too, am concerned that we may have to ask the Public Accounts Committee to investigate further.
In addition to that test, I ask my hon. Friend the Minister what measures the regional health executive officials are taking to ensure proper performance and adherence to corporate governance requirements for the future of the North Yorkshire ambulance trust, and, indeed, for the future of all national health service trusts. Has any performance recovery plan been established? I would like to know also whether that has been requested and whether such a plan will be published. Will the public of North Yorkshire be able to learn of the targets?
I wish to ascertain also whether my right hon. Friend the Secretary of State for Health will be giving detailed and early consideration to the future occupancy of key positions within the trust. I should like to see a serious re-evaluation of the appointments process within a key public service that extends across the country. The findings of the Galbraith report suggest that that should happen.
820 There are key questions of accountability and accessibility to the community served within such an important public service. These factors should be taken into account if any future design is made for improving guidelines for appointments to health trusts.
Some published mechanism should be established that allows for positive feedback from public servants within a no-blame, no-bully culture. That would allow and encourage a real team-building process. It would allow also an honesty of approach, to ensure that we have the most effective services from health trusts.
I would like the Minister, if it is possible, to deal with the rumours that are now abroad in North Yorkshire and Humberside about the possible merger of the two ambulance trusts. These rumours are sapping staff morale and causing loss of staff confidence. I am talking of people who have been knocked from pillar to post by the events that led to the Galbraith inquiry.
I believe that the North Yorkshire ambulance service has an identity of its own. In spite of the sorry management regime investigated by Mrs. Galbraith and her team, the service has developed a strong relationship with the people of North Yorkshire. Those who work in the service are to be commended for the work they do.
I should like to think that the problems caused by ineffective management that ensued over several years from the birth of the trust, and which have been outlined so clearly by the Galbraith report, will not be taken as a basis for any merger of services, which I believe to be geographically unsustainable.
It would not be in the best interests of the people of Scarborough and Whitby, or of those of North Yorkshire or the national community, for us to be thinking about such a merger on the basis of the problems that I have outlined. I shall be interested to hear my hon. Friend's response.
§ Mr. John Greenway (Ryedale)
First, I apologise to you, Mr. Deputy Speaker, and to the hon. Member for Scarborough and Whitby (Mr. Quinn), for not being in the Chamber at the beginning of the debate. These half-hour debates usually start on time. Given the six minutes that it takes to walk from Millbank to the Chamber, I was not able to be in my place when the debate began because of the early start.
I congratulate the hon. Gentleman on securing this debate, and on the measured way in which he raised the issue of the North Yorkshire ambulance service.
I had thought of attempting to secure a similar Adjournment debate, but I concluded that I would not do so, for reasons that I now declare. Mr. Murray Naylor, who was until recently the chairman of the trust, and who resigned as a result of the Galbraith report, is a personal friend. As the hon. Member for City of York (Mr. Bayley) will know, he is now a Conservative council councillor, and is the former chairman of the Ryedale Conservative Association.
However, it is fair, from the point of view of balance, to place on record the fact that the criticism of Mr. Naylor in the Galbraith report was small. In relation to some of the other difficulties that the health service has encountered in recent years, this problem, important though it is, is by no means on the same scale.
821 In my view, nothing in the report justifies Mr. Naylor's resignation. However, in resigning from the trust, he took an honourable course, and acted with great speed and integrity. I can advise the House that he did so after much soul searching about what was best for the North Yorkshire ambulance service. He felt that, as the report contained criticism of him, the right, proper and honourable thing to do was to tender his resignation, and that he did.
The Galbraith report came about as a result of a "Dispatches" programme on Channel 4. The hon. Member for Scarborough and Whitby made it clear that the report concluded that some of the most serious allegations in the programme were not justified. It is important that the House, the Minister and the people of North Yorkshire recognise that the serious allegation that response times had been deliberately manipulated was not found proven, although it was found that, in a marginal sense, they had been overestimated.
The allegation that defibrillators did not work and were not properly maintained has serious implications for the national picture. However, the Galbraith inquiry found that not to be the case, although the report implied that this is a national problem, and that defibrillator equipment should be upgraded across the ambulance service.
It was those two key allegations in the Channel 4 programme that most shocked the people of North Yorkshire, and gave rise to the greatest degree of public concern. Time does not allow an in-depth analysis of other aspects of the report, except to say that it acknowledges that the ambulance service has made substantial progress, and that considerable improvements have been made in the four years since the trust was established.
After the Channel 4 programme, I visited the two ambulance stations at Malton and Filey in my constituency. I had a completely open mind, and gave ambulance crews and staff the opportunity to say precisely what they thought: that is particularly important, given the allegations of bullying of members of staff by the former chief executive, Mr. King, who the report acknowledges had an extremely robust style of management. They told me that the trust had brought about improvements, but that issues in the report still concerned them. That is undoubtedly the case.
I conclude by making two points. First, I want to pick up on the point made by the hon. Member for Scarborough and Whitby about the future of the North Yorkshire ambulance service. It concerns me greatly that people in the NHS executive and in the Yorkshire and Humberside regional office may seize on this report and these events and use them as an excuse to merge the North Yorkshire ambulance trust with another trust, such as Humberside or West Yorkshire, or to merge all three.
I think that I can speak for my colleagues in North Yorkshire—judging from what the hon. Member for Scarborough and Whitby said, Labour Members share my view—when I say that the case has not been made for such a merger. North Yorkshire is by far and away England's largest county. I know, Mr. Deputy Speaker, that you represent a large rural area in Suffolk, but when one considers that the distance from the border with the North sea in my constituency and that of the hon. Gentleman to the most westerly part of North Yorkshire is greater than the distance from Southend to Bristol, 822 one can understand our concern that there would be serious logistical difficulties in forcing through a merger. There should be a proper public debate about this issue.
I do not believe that there is support for a merger in the York area. I know that it is difficult, because of his position, for the hon. Member for City of York to participate in the debate, but I am sure that he would agree with me that people in the York area, which we both represent, would be very concerned if, in spite of the problems that have been experienced, the ambulance headquarters at Skelton on the edge of York were to be closed and operations and decision making transferred to Hull or Leeds. That would be a seriously retrograde step.
The second point that I want to make is very much along the same lines. The hon. Member for Scarborough and Whitby referred to an accident on the A64, and the difficulty of the response time. The problem is that there is no ambulance station between Malton and Scarborough or Filey. It takes me 38 minutes to drive from my office, which is half a mile from the Malton ambulance station, to the next ambulance station at Filey; and that is on a good day. On a Saturday in June, July or August, when the A64 is chock-full with traffic, it takes easily an hour to do that journey. The hon. Gentleman knows what the problem is, because he lives in Scarborough.
If we are to impose on the ambulance service the 19-minute national response requirement, some regard must be given to the problems of dealing with such a huge rural area. That is the message that I received from ambulance crews. They say to me, "Mr. Greenway, it is all very well people complaining that it took 35, 40 or 45 minutes, as in one of the incidents in the Channel 4 programme, but people should try driving some of these distances in their own cars."
I am not making a plea for another ambulance station, but I hope that the Minister will study this problem and the difficulty associated with covering the area with communications systems and radios. There are several fire stations and other police premises between those ambulance stations, but there is no ambulance station between Malton and Filey or Scarborough. That is a huge distance to cover, and there are other problems in similar parts of North Yorkshire.
When we consider the difficulties that the ambulance trust and the ambulance service in North Yorkshire have faced in recent months, we should recognise that, by and large, they do an extremely good job, and that the people of North Yorkshire have a high regard for them.
§ The Minister of State for Public Health (Ms Tessa Jowell)
I am glad to have the opportunity to respond to my hon. Friend the Member for Scarborough and Whitby (Mr. Quinn), and I congratulate him on securing a debate on a matter of such importance to his constituents. I listened carefully to him, and to the hon. Member for Ryedale (Mr. Greenway). They expressed important concerns about the North Yorkshire ambulance service trust. My hon. Friend is right to pursue his concerns with great vigour on behalf of his constituents.
My hon. Friend outlined clearly the background to the independent review and the recent report. I should like to make it clear that, although the report was commissioned and the inquiry panel established under the previous 823 Administration, panel members were appointed jointly with the National Health Service Executive regional office.
When it first sat, the panel amended and extended the terms of reference initially suggested for it by the trust. It is, however, important for us to look forward. We should take account of the lessons that can be learned, both in north Yorkshire and by the ambulance service regionally and throughout the country, from what was a series of disturbing incidents. What matters is the allaying of public concern—which is great, following events such as the one that we have been discussing—and the rebuilding of public confidence.
As my hon. Friend said, the independent review panel was chaired by Anne Galbraith, chair of the Newcastle Royal Victoria Infirmary and Associated Hospitals NHS trust. It was formally appointed on 25 November last year, and undertook to investigate nine of the areas of concern that were identified by the "Dispatches" programme and in other charges.
There were allegations of deliberate manipulation of response times. There was a demand for justification of the trust's decision to purchase a new control and communications system. It was alleged that the trust was in arrears with its paramedic training and reassessment programme, owing to a failure to invest in proper training; that it had failed to replace its defibrillators because of a lack of investment, and that that might have caused defibrillators to fail; and that, owing to a lack of investment in radio infrastructure, the low level of radio coverage in parts of the operational area had caused ambulances to be delayed.
It was asked whether line management relationships had affected the trust's operational effectiveness, whether non-executive directors had been kept appropriately informed, and whether the trust's approach to income generation had affected its operational effectiveness. It was also asked whether the trust had committed expenditure to public relations at the expense of operational services, and—specifically in relation to the tragic case of James Dean—whether it had applied any of the lessons that it had learned in practice.
Submissions to the review were invited from staff and former staff of the trust, the trust board and external organisations and individuals, including Members of Parliament. The panel conducted what was described as a thorough investigation of the technical and managerial issues raised by its terms of reference, and sought from the outset to gather comprehensive information about the trust's performance.
Time was spent in discussion with a wide range of individuals and groups, and consultation was undertaken with both the trust board and union representatives. The report was published in full on 3 June 1997, just over six months after the screening of "Dispatches". Having looked at the programme of work, and following meetings, the panel set about its task with commendable urgency.
Let me now deal with the criticisms of the trust that were made in the report, and inform my hon. Friend and the hon. Member for Ryedale of the action being taken in response to those criticisms. The public, after all, have a right to expect problems that have been identified to be 824 resolved swiftly. The North Yorkshire ambulance service is now under a new management team, which is tackling the urgent need to improve performance.
Let me make it clear that I am here to report on the findings of the review panel, and on steps taken by the NHS executive in the light of those findings. It is for public opinion, articulated by local Members of Parliament, to judge whether enough has yet been done.
In the light of today's debate, and having listened carefully to what was said by my hon. Friend and the hon. Gentleman, I shall ask the regional office to prepare a set of clear performance targets that the ambulance trust will be expected to meet. I hope that those targets will be widely disseminated, as will the extent to which they are met, as part of the important process of rebuilding public trust and confidence in the service.
A number of criticisms were made of the trust's management. The hon. Member for Ryedale referred to what was described as the harsh, arbitrary and inflexible leadership style that had had an impact on the trust's operational effectiveness. I understand that the chief executive who was the source of that complaint has now retired on grounds of ill health—that was mentioned by my hon. Friend—and that the chairman has also resigned. Indeed, I acknowledged his resignation only a few days ago.
I am told that staff consultation arrangements have been overhauled by the new management team. A number of groups of staff have been organised to review the trust's policies on such matters as disciplinary and grievance procedures, and health and safety matters. The trust plans to introduce an "investors in people" award, which we hope will ensure the effective involvement of staff in the running of the service. Staff side representatives have publicly recorded their view that morale has improved, and that the new management team is working effectively with staff. I hope that that will translate rapidly into improved performance by the service.
Many criticisms were made, and the responses to them are clearly set out in the report—to which I refer hon. Members who are interested. The public will be concerned about, for instance, the trust's alleged failure to deal separately with income generation calls and emergency calls, fearing that that may have interfered with operational efficiency. I understand that the trust acted swiftly to separate those very different types of call immediately after the "Dispatches" programme, and that careful monitoring of them is now under way. I also understand that further training has been secured for paramedics, and that two additional instructor posts are being advertised to meet future training requirements.
Let me refer to one of the gravest allegations, relating to the collection of performance statistics on ambulance response times. The review panel found no evidence of systematic falsification of results, but the panel felt that access to computer records was insufficiently controlled, and left the trust open to allegations of manipulation of the data collected. Having read the report carefully, I can confirm that view. I am told that the trust has taken steps to address the panel's concern, including the monitoring of the use of the system on a continuing basis to ensure data integrity.
In many respects, the best judges of whether the service has learnt the lessons of the James Dean case are James Dean's family, and I hope that they will be kept in close 825 touch with the way in which what has been learned from his tragic death is being applied in practice. The trust now has a new acting chairman and a new acting chief executive. I assure my hon. Friend that developments in the trust will be kept under the closest scrutiny by the regional office, which will also be asked to establish the performance benchmarks to which I referred earlier.
Questions were raised about concern about merger proposals. I can confirm that no formal proposals have been received by me, or by the regional office. New appointments to the trust board will, of course, follow full Nolan procedures in relation to openness.
What matters now is rebuilding confidence, and applying the lessons learned from a bad episode to ambulance services throughout the country. The constituents of 826 my hon. Friend and the hon. Member for Ryedale deserve an ambulance service that truly meets the highest demands placed on ambulance services to respond to emergencies. I will ensure that the Government make every effort to make certain that that happens.
§ 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.