§ 2.56 p.m.
§ Baroness Masham of IltonMy Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
§ The Question was as follows:
§ To ask Her Majesty's Government whether they are in favour of advanced training for ambulance personnel undertaking emergency work, so that they are trained in the life support skills.
§ Lord Cullen of AshbourneMy Lords, there is evidence that advanced training may enable ambulancemen to provide an improved service to patients, but it is not yet clear that the overall benefits are sufficient to justify the cost, which would in any event need to be weighed against other claims on National Health Service resources. The Government will also wish to take into account the report we are expecting shortly from the National Health Service Working Party on Patient Transport Services. While this has not been considering training as such, its views on the more general role of the ambulance service could well have implications for training needs. A number of ambulancemen voluntarily undergo training in more advanced techniques and we are aware that some health authorities have their own schemes; this is a matter for them to decide in relation to other claims on the resources available locally.
§ Baroness Masham of IltonMy Lords, I thank the noble Lord the Minister for that reply. Is he aware that the overall cost of disability arising from the lack of life support skills is likely to be far greater than the cost of training selected ambulance personnel in these skills? Is he aware that many casualty departments in hospitals have closed and that patients have to travel a long way? Is it right that there should be marvellous, expensive, highly skilled intensive care units and the patient dies, or becomes disabled, on the way?
§ Lord Cullen of AshbourneMy Lords, I think that this matter is slightly more complicated than it seems to be at first sight. First of all, of the work of the ambulancemen less than 10 per cent. is on emergency cases. The whole question of the role and structure of the ambulance service has just been reviewed. The report is in front of the regional health authorities at the moment. It will come to the Secretary of State probably next month, and the whole situation is being looked at.
§ Baroness Masham of IltonMy Lords, following on from that, may I ask the noble Lord whether the Secretary of State will take into consideration the situation in America and Australasia where paramedics very successfully undertake this work?
§ Lord Cullen of AshbourneYes, my Lords; the whole experience in this country of various experimental schemes and the experience abroad will certainly be taken into account. I know that there are very successful schemes in Australasia and America, although of course they are localised.
§ Lord SegalMy Lords, is the noble Lord aware that in many cases lives have been saved by the skilled emergency treatment rendered by ambulance teams? Could not some distinctive badge of merit be awarded to those who have specially qualified in this highly skilled advanced training?
§ Lord Cullen of AshbourneMy Lords, I am certainly aware that many lives have been saved by ambulance-men. The noble Baroness is asking whether further advanced training should be given to them. This is a complicated matter which also affects the unions.
Lord WinstanleyMy Lords, is the Minister aware that of those who die from coronary thrombosis, about half die within the first two hours and that of those, about half die from rhythm disturbances which could be reversed with the right treatment at the right time, which is in the ambulance? Is he further aware that in Brighton, ambulance drivers have voluntarily submitted to training in monitored heart care, defibrillation and so on with quite spectacular results in terms of the saving of lives? If that can happen in Brighton, why can it not happen elsewhere?
§ Lord Cullen of AshbourneMy Lords, I am well aware of the Brighton cardiac scheme and the successes they have had there. The general view is that this must be for the local authorities to consider in line with the resources they have, and it is questionable whether the number of lives saved is satisfactory compared with the cost of the service. This is a very important matter and is one of the main aspects that will be considered.
The Countess of LoudounMy Lords, is the Minister aware that expert resuscitation is vital to save oxygen being cut off from the brain, which causes mental handicap?
§ Lord Cullen of AshbourneI am sure that is true, my Lords.
§ The Earl of SwintonMy Lords, when the Secretary of State is considering this matter, will special thought be given to the needs of rural areas, where casualty departments are often a very long way from the scene of the accident and ambulances must travel enormous distances before arriving at the place where the patient is suffering and is in need? Is the Minister therefore aware of the very special need that exists in some of the isolated parts of the country?
§ Lord Cullen of AshbourneMy Lords, I do not wish to disappoint my noble friend, but obviously this is a difficult matter when it comes to the rural areas. As the noble Lord, Lord Winstanley, mentioned, the important thing is to get the ambulance to the patient very quickly. To do that in isolated rural areas would seem a very difficult thing to do.
§ Lord PorrittMy Lords, would the Minister be willing to consult the Medical Commission on Accident Prevention who have looked into this subject for the past 10 years, who are very knowledgeable about it, who run a number of very successful courses in the southern counties and who voluntarily give a certificate to those who become trained up to the point which we are discussing?
§ Lord Cullen of AshbourneYes, my Lords; all the people who are interested in this matter will be consulted and in fact have been consulted on the report which is now going to regional health authorities.
§ Baroness Hylton-FosterDo ambulance personnel undergo regular refresher training to keep up with ever-changing modern techniques, my Lords?
§ Lord Cullen of AshbourneI believe the answer is that it varies, my Lords. Certainly it is the intention that all ambulancemen should have, I think within two years, refresher courses; I am not able to say that they all have them.
§ Baroness Masham of IltonMy Lords, in view of the unsatisfactory reply which the Minister gave to my noble husband about rural areas, may I ask whether the Secretary of State and the Government will very seriously consider introducing a helicopter flying squad service for the rural areas?
§ Lord Cullen of AshbourneI would rather doubt that, quite honestly, my Lords, because we must consider the costs of quite simple arrangements, and I think that to have helicopters flying all over the country to outlying areas would be a very advanced move and unlikely to be considered at any rate in the early stages.
§ Baroness Masham of IltonMy Lords, is the Minister aware that they have such a service in Southern Ireland?
§ Lord Cullen of AshbourneI believe they do, my Lords.
The Minister of State, Ministry of Agriculture, Fisheries and Food (Earl Ferrers)My Lords, I think it would be appropriate if we moved on to the next Question.