HL Deb 25 February 1993 vol 543 cc355-61

4.30 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)

My Lords, this may be a convenient moment to repeat in the form of a Statement an Answer to a Private Notice Question being given in another place by my right honourable friend the Secretary of State for Health. It is as follows: "The House will recall that last October I asked the South West Thames Regional Health Authority to commission an independent inquiry into the operation of the computer aided despatch system of the London Ambulance Service. This followed occasions on which the system had seriously failed. That independent inquiry has now reported, and I am grateful to Mr. Don Page and his team for the thorough way in which the task was discharged.

"The report finds that there were a series of failures on all sides in the implementation of the computer aided despatch system. It concludes that these were attributable largely to the pace at which this new system was installed, following on from the very damaging ambulancemen's strike in 1990.

"I take a very serious view of the catalogue of errors which the report has highlighted. These are unacceptable and must not be repeated. In a meeting with both the South West Thames Regional Health Authority and the London Ambulance Service yesterday, I made clear the gravity of the situation and the importance which all those concerned with the London Ambulance Service will attach to the speedy rectification of mistakes and to learning lessons from what has gone before.

"I remain to be convinced that the lines of management accountability between the London Ambulance Service and ultimately Ministers are sufficiently robust. Accordingly, I have instructed Professor Marian Hicks, chairman of the South West Thames Regional Health Authority, to produce proposals within one month for strengthening the lines of accountability. I note that Mr. Jim Harris, chairman of the LAS board, has decided to step down, with effect from Monday, in order to allow that process to proceed without inappropriate distraction.

"The House should be reassured, however, that significant managerial changes have already taken place at the LAS since the report was commissioned. In particular, a new chief executive, Mr. Martin Gorham, has been appointed, following the resignation of John Wilby. He has taken considerable steps to improve both management and industrial relations at the service. I am also pleased to note that the LAS will be appointing an information technology director to oversee the staged reimplementation of an effective computer aided despatch system.

"The House will also want to know Of the significant improvements in service standards which have taken place since the autumn. 999 calls are now answered within an average of six seconds. Ambulance response times are now some 15 per cent. above the level to which they fell last summer. However, they remain well below the levels in other metropolitan areas.

"The report recognises that London is a special case. However, the fact that other ambulance services continue to provide a much better service in terms of response time than the LAS, often with far fewer resources, must give the service and those who work for it considerable food for thought. These problems must be tackled. In particular, I wish to see an early start made to the negotiation of new rosters with the union side which will put more ambulances on the road and improve the service to patients.

"I have asked Professor Hicks to provide me with regular reports on progress. We will be agreeing new objectives with the authority to achieve national standards as soon as possible. By then we will also want to see evidence of further improvements in the service's personnel and financial performance.

"Both the regional health authority and the London Ambulance Service itself have embraced the findings of the independent inquiry. A series of important managerial steps are now in place in response. These will improve the management of the service, management and staff relations and accountability to local people. The result will be improvements to the service for London patients which London expects and London must get."

My Lords, that concludes the Statement.

4.35 p.m.

Lord Desai

My Lords, I thank the noble Baroness for repeating the Answer to a Private Notice Question in another place. I must confess that this is a rather new experience for me. I have not had a chance properly to peruse the report of the inquiry, as I only received it about five minutes ago.

This is a very serious matter in a number of ways. Even from a very quick perusal, the report shows that there has been a very serious failure of management. I have used computers for 30 of the 52 years of my life. I have never known any computer system work on first trial. It is universally true that computer systems, especially when they are being changed over, promise too much. It takes some time before all the bugs are eliminated and they become user friendly. That should have been known and taken care of. There should have been pilot projects and dry runs before the system was put into operation.

The pressure on management which resulted in the great hurry with which the system was put into operation, the lack of consultation with the staff who had to use the system and, I gather from the report, a climate of mistrust of the employees on the part of the management added to the problems. It is remarkable that we have had one more resignation on this round from the London Ambulance Service. Somebody has taken responsibility this time.

I welcome the report, though I would like to have seen slightly more about the lines of management between the London Ambulance Service, the regional health authority and the Department of Health. We ought to be very aware that when my friends in another place asked for an inquiry, again and again they were fobbed off by the Secretary of State and junior Ministers. It was correct to ask for an inquiry; but it. was left too late. It is rather tragic. The full extent of the difficulties caused by the failure is not known. However, it is noted in this morning's Independent that the London Ambulance Service has had to give evidence at more than 20 coroner's courts since the breakdown last October. I say no more. This is a serious matter.

The Statement on the Tomlinson Report made last week mentioned that the reforms would be implemented in the expectation that the London Ambulance Service would be able to take the burden of the running down of the accident and emergency units at Bart's and other reorganisation. The same mistake must not be made again. Let there be no reorganisation until we are quite sure that the London Ambulance Service can handle the burdens and we have had enough dry runs. We should not get into another hasty reform.

It is remarkable how the report mentions that in asking for open tendering the quantitative rather than the qualitative aspect was emphasised. That was a polite way of saying that we looked for the cheapest service but not the best service. The whole matter of the trust status of ambulance services has a question mark over it. Management systems must be thoroughly improved until we are satisfied that people know what they are about. I am absolutely astonished that an information technology director is now being appointed in the London Ambulance Service. Such a director should have been in place long ago. I should have liked to see a little more responsibility taken at a higher level than we have heard about this afternoon.

Baroness Hamwee

My Lords, we thank the Minister for repeating the Answer to the Private Notice Question. To apologise is not to excuse, but I welcome the tone of humility that I detected. Many noble Lords must have experienced computers failing or not producing the magic that was expected of them, but no good workman blames his tools. I am astounded to hear that only now is an IT director to be appointed. An IT director should have been appointed before the specification for the new design system was written and into which an inquiry has been made. Noble Lords will forgive me for referring to local authorities—that is my background—but I doubt that they would have been allowed to get away with a specification which was clearly inadequate.

The noble Lord, Lord Desai, rightly referred to the lines of accountability. I note the resignation of the chairman in order to enable a review of accountability. No one would have wished that situation to have arisen, but it is accepted to be an appropriate resignation, although it is a recognition of the problem and not a solution.

I hope that in assessing the accountability and the workings of the service the managers will take on board the advice offered and comments made by the ambulance personnel who operate the service on a day to day basis. The climate of distress that has been mentioned has had a good deal of publicity over a very long period.

Can the Minister comment on other reports in the press today as to the level of complaints and the new systems for dealing with complaints? Can she reassure noble Lords that staff will be trained to deal with complaints? It appears that of the five staff who were dealing with complaints, only one was doing so full time and that none of them had any training.

I should be grateful if the Minister would comment on the vehicles that are used by the service and their fitness. Before the crisis last October, I recall reading reports that vehicles were not always fit. The fact that vehicles could not be put on the road was causing problems.

I return to the underlying point. The report deals with the narrow issue of the crisis of last October. I welcome the fact that it is clearly being applied more widely. There have been many calls for a full inquiry into the workings of the London Ambulance Service. The people of London need to be reassured that, although the acute problem may have been tackled, to use health jargon there is a real prospect of dealing with the chronic and, if I may say so at a political level, of ensuring that the service is not driven by dogma.

Baroness Cumberlege

My Lords, I should like to reply to the points made by the noble Lord, Lord Desai, who detailed some management failures. The Government accept those criticisms. That is why my right honourable friend the Secretary of State for Health has asked the South West Thames Regional Health Authority to examine the lines of management accountability. However, I should like to stress that the London Ambulance Service is the largest and most complex ambulance service in the United Kingdom.

The South West Thames Regional Health Authority is committed to improving the service. The region has acknowledged the point that the LAS management tried to do too much too soon and that that very ambitious approach alienated staff. It recognises that if it is to succeed in the future, it has to work closely with staff and take them with it; and that includes training and other aspects of the service.

The region acknowledges that a more measured and participative approach is required, which is something that will be introduced.

I should like to correct a misconception that may have arisen that the London Ambulance Service is a cheap service. It is not: it has a budget of £70 million, which is an increase of nearly 9 per cent. over last year. We have the responsibility of ensuring that the money is effectively spent. The region is therefore looking carefully at the recommendations in the report and at any resource implications.

Lord Desai

My Lords, I should like to thank the noble Baroness for giving way. I did not state that the service was cheap. I stated that in commissioning the CAD system cheapness was emphasised rather than quality.

Baroness Cumberlege

My Lords, I accept the point made by the noble Lord. The regional health authority is looking at the specification documents and procurement processes to see what revisions need to be made.

The noble Baroness, Lady Hamwee, raised the question of specification. It is correct to state that in the past the situation has not been satisfactory. The management executive sent a letter to the National Health Service in relation to that point, giving guidance and a £1 million limit on new schemes involving computers. The sanction of the management executive will be required before they are procured.

The level of complaints is high and, therefore, further staff have been recruited to deal with that aspect of the service. However, the Secretary of State and her Ministers hope that so many staff will not be required in the future because there will not be so many complaints. Clearly, the service has to improve before that situation is reached.

The noble Baroness raised the subject of vehicles. Since 1991 290 new vehicles have been purchased, which represent 36 per cent. of the London ambulance fleet. A further 30 A and E vehicles have recently been ordered and the London Ambulance Service is committed to spending two-thirds of its capital allocation on vehicle replacement. Therefore, within a period of five years, we should see a very different fleet.

4.47 p.m.

Lord Auckland

My Lords, I have not had an opportunity of seeing a copy of the Statement but I have followed some of the correspondence. Will the Minister put on record that the London Ambulance Service has the praise of all sections of the community, whatever problems are raised in the report?

Being of an age when I do not understand computers, can I ask the Minister whether more comprehensive training will be given to those who operate them? Can she say whether, as a result of the disturbing events, recruitment has been affected? In view of the implications of the Tomlinson Report, will it not be more difficult for ambulances to reach casualty areas if casualty departments in some of the London hospitals, particularly in this area, are being scaled down?

Baroness Cumberlege

My Lords, a great deal of emphasis has been put on training ambulance personnel, not only in the administrative system in terms of computers, but very much in terms of service delivery. The number of paramedics within the service has been increased remarkably.

I do not have the figures for recruitment. I am not sure whether it is keeping pace with past experience, but I know that the absenteeism rate has been steady. We should like to see that figure reduced. It has not increased, which is perhaps one indicator of staff satisfaction.

Lord Ewing of Kirkford

My Lords, does the noble Baroness agree that the Statement tells us that the introduction of the computer aided despatch system in London was an absolute shambles? It was a new system. Will she and her colleagues learn a lesson from that shambles and disregard the proposals made by the Director General of Oftel and British Telecom to move the 999 emergency call system away from British Telecom to a so far unnamed private agency?

Will the Minister make clear to the Director General of Oftel and to British Telecom that dealing with emergency calls on the 999 system is a highly specialised matter for which many telephone operators have been trained extensively over many years? And will the Minister therefore make it clear at this early stage that these madcap proposals should be dropped?

Baroness Cumberlege

My Lords, the future plans of Oftel are not a matter for me.