EMERGENCY MEDICAL CARE

HL Deb 12 July 2004 vol 663 cc1066-74

1. A fire and rescue authority must make provision for the purpose of—
1. delivering emergency medical care to persons seriously injured by fire or the effects of fire;
2. delivering emergency medical care to persons injured in road traffic accidents; and
3. providing other emergency medical care;
2. in situations where employees of the authority are first on the scene of an incident in relation to which the authority has functions under sections 7, 8 and 9.
3. The level of provision that must be made under subsection (1) above is that which it is reasonable to make having regard to—
1. the number of such incidents to which the authority is required to respond;
2. the typical period of time during which the authority's employees are at the scene before the arrival of specialist medical or paramedical personnel; and
3. the conclusions of the consultation referred to in subsection (3).
4. A fire and rescue authority must consult not less than once in every two years each National Health Service Ambulance Trust which has responsibility for responding to emergency incidents within its area about the level of provision it is appropriate for the authority to make in accordance with subsection (1)."

The noble Lord said: My Lords, in Committee we had a useful discussion about fire engines carrying defibrillators and firemen being trained to use them in first-responder and co-responder schemes and attempts to ensure that the fire service would be able to have emergency medical capabilities.

By tabling Amendment No. 22 again, I am seeking to bring some kind of closure to this aspect of the Bill as I think that last time we all agreed with the principle behind the amendment. However, we did not necessarily agree the vehicle for supporting this principle.

The Minister said that Clause 11(2)(a) provided clear legal authority to fire services personnel to undertake training and administer treatment. Can the Minister perhaps indicate how emergency medical cover can be flagged up in guidance regarding Clause 11 and how it can be made clear to fire and rescue authorities that carrying defibrillators for use on the general public is a perfectly reasonable thing to do?

The Minister also said that although he could not agree with emergency medical care becoming a core function of the fire and rescue services, he commended the fact that firefighters often provide at the scene lifesaving assistance by stabilising victims before the ambulance arrives. As I made clear last time, the gap that the amendment addresses was identified in the Bain report. Our debate last time also raised the important point about what public expectations are in this area. Having re-read in Hansard the Minister's reply to the amendment, I feel that he needs to go a little further in explaining the Government's position. It seems to be a continuation of the status quo.

However, according to the Deputy Prime Minister, the status quo is a "postcode lottery" when it comes to the emergency provision of medical care, which he claimed was unacceptable. Thus, there seems to be a gap between that sentiment and the Minister's view, which essentially keeps things as they are, so that it is left to the fire and rescue authorities to decide what they will do, if anything, by way of emergency medical care. I would appreciate it if the Minister could reconcile those two views and clearly state the Government's position. I beg to move.

6.30 p.m.

Lord Rooker:

My Lords, I think that the short answer based on the note I have—I shall give a considered reply—is that we want it to happen, but that we do not think it should be a statutory duty. The amendment would create a new duty on all fire and rescue authorities to make provision to deliver emergency medical assistance where the fire and rescue service personnel are first on the scene of an incident in relation to which they have functions under the various parts of the Bill.

In determining the level of provision, each fire and rescue authority would have to take account of what was reasonable, including the likely number of incidents attended and the period of time before the arrival of specialist medical staff. Each fire and rescue authority would also be required to consult the NHS ambulance trust operating in its area at least once every two years.

We debated at some length the same amendment in Grand Committee. I fully accept that it is right to bring it back, but I will only repeat the arguments. We recognise the underlying aim of the amendment. We would like it to happen, but it should not be a statutory duty. The Government's view is that to extend the duties in this statutory way as proposed would be unhelpful.

It goes without saying that the aim of the emergency service response is to reduce deaths and the severity of injuries. Adopting new ways of working and co-operating more with other emergency services can greatly improve the service provided to the public. That is why we have made it clear in the draft Fire and Rescue National Framework that fire and rescue authorities should explore the benefits of working with others, including, for example, by implementing co-responder schemes.

Under Clause 11, we are giving fire and rescue authorities the power to equip for and respond to a range of scenarios, and co-responder initiatives could form a part of that response. However, we do not believe that it would be appropriate to make it a statutory duty. It comes down to the fact that in this House, from the point of view of being at the centre, we have to trust people at the locality running the schemes to make their best judgment. They will depend on many factors, and they will have responsibility for delivering the schemes. We think they should determine this issue.

Clause 11 will remove any doubt about the power of fire and rescue authorities to instruct staff to implement such powers. We have made it clear that the final decision should be made locally.

Lord Hanningfield:

My Lords, perhaps I may intervene. I particularly asked not necessarily for the provision to be on the face of the Bill, but for guidance regarding Clause 11 to be stronger, because it could obviously save lives. Will the Minister comment on the guidance on Clause 11?

Lord Rooker:

My Lords, I shall do so when I come to it. I am trying to give a full response. I shall give a response to the noble Lord's point. This is an important part of the Bill and I want to place a couple more paragraphs on the record for people following our proceedings.

For their own health and safety, firefighters have emergency first aid expertise which encompasses life saving skills. These are skills that firefighters already provide, where appropriate, to injured members of the public at the scene of an incident before the ambulance service arrives.

However, responsibility for ensuring reasonable provision of emergency first aid and pre-hospital care rests with the Secretary of State for Health through the ambulance service. We do not want two emergency services prepared and trained to deliver medical assistance.

I turn to the noble Lord's point. The national framework encourages fire and rescue authorities to work with other services. We will highlight the scope of Clause 11 to authorities when offering guidance on the provisions of the Bill. So it will be clearly there in the guidance and in the Act if the Bill gets enacted, which I suspect it probably will.

Baroness Hanham:

My Lords, before the Minister sits down, where the fire and rescue service arrives first on the scene of a really serious accident and someone is in the process of having or has had a heart attack, are the members of the fire and rescue service who are able to do so entitled to take action to help that person? Every shop, business and office has people trained to a very high degree in first aid and including the use of defibrillators. I am not aware that they are restricted to dealing only with their staff. Are those who are already appropriately trained in the fire and rescue service able to deal with an emergency when they arrive at an accident without necessarily having to wait for the paramedics or the ambulance to arrive, thereby saving people's lives by using their skills? Are they able to do that?

Lord Rooker:

My Lords, one cannot describe the circumstances because the implication is that there is no fire—this is a road traffic accident. A fire could be raging. The fire service arrives to put the fire out and save lives and buildings. Let us be clear that saving lives is more important than saving buildings. But if they can give first-aid treatment in advance of the paramedics arriving they are able to do so. They are not banned from doing so. Sometimes they carry equipment in their appliances which would assist them.

That is not always necessarily the case. But there is no ban on people helping other people. Firefighters going to fight a fire may find people who they are able to assist before the paramedics arrive. There is no ban on them helping in that way. The amendment seems to make it a statutory duty to carry the equipment and have the training. It is best left to the local fire authorities in conjunction with partnership arrangements and co-responder schemes to make those kinds of arrangements in a formal way, but there is nothing to stop them assisting people in the circumstances the noble Baroness explained.

Baroness Hanham:

My Lords, I know I should not keep standing up at this stage, but this is an important aspect. Equally, therefore, there would not be any restriction on a fire and rescue service saying it would be normal practice, for example, to carry a defibrillator in every appliance, so that if necessary it could be used and that at least one member of every crew should be able to deal with first aid in an emergency.

Lord Rooker:

My Lords, my understanding is that that is entirely within the remit of a fire and rescue service. It is not on the face of the Bill, but that is a matter that the services can decide. They are not banned from doing so by the Bill.

Lord Hanningfield:

My Lords, we have had an interesting exchange between my noble friend Lady Hanham and the Minister. The noble Lord rather disturbed me. He indicated that most of the activity of the fire and rescue service concerns fires. It is not. Fires are a fairly small part of their work these days. As my noble friend said, they get to accident scenes first most of the time. Therefore, there is a potential life-saving element to all this. That is why we are keen to explore it. We have to accept what the Minister has said today. He has said that the Government will issue good guidance for Clause 11. I hope the Government will stick to that. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 9 [Emergencies]:

Baroness Hanham

moved Amendment No. 23:

Page 6, line 39, at end insert— "( ) An order under the section conferring a function additional to its function under sections 7 and 8 for which a fire and rescue authority must make provision, shall also provide for the payment to that authority by the Secretary of State of sums calculated to meet the capital and recurring costs of such function."

The noble Baroness said: My Lords, Amendment No. 23 provides that the Secretary of State should pay for the cost of conferring specialist responsibilities on fire and rescue authorities. When we discussed the matter in Grand Committee the Minister gave a response which was reassuring but did not address the principle of the amendment. If I explain what I mean by that, I hope the House will understand why we have returned to the subject.

The Minister reassured us by making it clear that in terms of the new dimensional work carried out in the operational environment of the fire and rescue services, the Government will fund these arrangements. The figures he gave us were £188 million over a three-year period. However, that should not disguise the fact that the Minister's reply was not satisfactory for two reasons. First, he did not address the crux of the matter, which was summed up neatly by the noble Baroness, Lady Hamwee, with the question: while the Government may think the amendment is unnecessary in 2004, what about in 2014? We are talking about large amounts of money. There should be something in the Bill that effectively closes the loophole that would allow a government to pass off costs that are properly their responsibility on to fire and rescue authorities.

The second reason for our return to the issue is that the Minister commented that the new Bill, which, as we all know, replaces an Act now nearly 60 years old, will have a better chance of standing the test of time if it is not loaded with unnecessary detail. We have been plugging away to get a little more detail into the Bill; it would be helpful. The Minister's comment is disingenuous. The new legislation will stand the test of time if it is credible and workable; it will be so only if we can be absolutely clear who pays for what.

We must avoid the kind of clashes that we saw between central and local government over, for example, council tax rises. If the Government admit that the kind of functions conferred in Clause 9 should be paid for by central government, why risk inviting problems of uncertainty further down the line by not addressing that in the Bill? The amendment not only makes this part of the legislation fairer but also will help to head off potential arguments about financing these services in the future. I beg to move.

Lord Rooker:

My Lords, I wish to clarify that if a new burden is placed on a fire and rescue authority, it will be dealt with under the new burden rules, which we follow meticulously in financial arrangements. In response to the points that the noble Baroness raised about the extra money in the New Dimension programme, we recognise the need to provide ongoing funding for resilience purposes and will be doing that in consultation with the Chief Fire Officers' Association and the Local Government Association, so long as the need exists.

There is also the implication of what she said about the ongoing costs of dealing with such incidents. We believe that we have in place arrangements for funding New Dimension incidents. The Government will provide funding annually from 2005–06 to meet the crewing needs of this investment. The level of funding and the means of its allocation is the subject of ongoing continuing discussions at present between authorities, the Local Government Association and central government. We do not think that the Bill needs to make separate provision for that.

The draft order places a duty on fire and rescue authorities to plan and equip for emergencies, such as flooding and chemical spills. Much of fire and rescue services' time is already spent dealing with such non-fire emergencies, as the noble Lord, Lord Hanningfield, has just said; they are known as special service incidents. They have acquired a range of equipment and expertise in these matters. It is worth putting on record that in 2002–03 the total number of special service incidents, excluding road traffic incidents, accounted for 12.7 per cent of all operational incidents attended by fire and rescue authorities in England. We are simply creating a clear framework in the Bill to enable the fire and rescue authorities to plan and respond to some of these incidents. The costs of dealing with such incidents are met from existing fire and rescue authority funding streams.

If, as a result of a Clause 9 order, a new burden is placed on a fire and rescue authority, it will be dealt with under the new burden rules. At the moment, the only new challenge in the draft order is responding to the increased terrorist threat. We recognise that and have funded accordingly, providing £188 million over three years, which includes training. We are also discussing with the Chief Fire Officers' Association and the Local Government Association the revenue implications of responding to New Dimension incidents. It does not matter where the work is carried out, whether it is in its own area or another fire and rescue authority area, the equipment, training and additional funding to cover resource costs will still have been provided by the Secretary of State. So we do not think that there is any need to make provision for an additional payment.

I remind noble Lords that the early draft of the order, of which they have a copy, is not yet available to the public. We expect to launch a full public consultation on it later this year. In many ways, the key issue is ensuring that we are not trying to get something on the cheap. If there is a new burden, it will have to be dealt with under the rules, which are set out clearly. Local authorities are not slow to point out the new burdens. We operate it meticulously. In any event, in my experience in Whitehall and from the papers that I see, Ministers' attention is drawn to the fact that this is a new burden and therefore will have to be paid for.

6.45 p.m.

Baroness Hanham:

My Lords, I thank the Minister for that reply; it more or less answers the situation. The only trouble is that Ministers have a great habit of pruning their budgets—where they see a new burden that might have been paid for a couple of years before, they suddenly decide that it can be taken out of the budget. We are talking about serious areas associated with the fire and rescue services, such as potential terrorist threats and others, as the Minister said. I accept now that the Government would ensure that the appropriate fire authority—that is what it would be; it would not necessarily be all of them—would be reimbursed. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 11 [Power to respond to other eventualities]:

Baroness Hanham

moved Amendment No. 24: Page 7, line 24, at end insert— ( ) The power conferred by subsection (1)(b) may be exercised outside as well as within the authority's area in respect of events or situations relating to functions conferred on the authority by the Secretary of State under section 9 with a requirement that such functions be discharged outside the authority's area.

The noble Baroness said: My Lords, in Committee, I did not feel that the Government got to grips with why we thought that the amendment was necessary. The proposed subsection would restrict the power under Clause 11 to functions conferred on the authority under Clause 9 and in respect of which the Secretary of State has given the authority an obligation to operate outside his area. We are talking about limiting the power on an authority to act outside its own area on discretionary matters.

The Minister said in Committee that an unintended consequence of the amendment would be to reduce local flexibility and the power to equip for any eventuality. We do not see why that is the case. The Minister gave the example of a co-responder scheme that addressed risks posed to the community. But this misses the point precisely because presumably this would happen within the authority's area. The point is rather that fire and rescue authorities are also empowered by Clause 11(4) to respond to eventualities, broadly defined, in other authorities' areas.

We want to avoid a situation arising where two neighbouring authorities, which might have very different priorities in their discretionary services, can interpret this part of the legislation as giving them a free pass to set up various discretionary services in a neighbouring authority's area because they have identified this as necessary in their integrated risk plans. Can the Minister say whether there is anything to stop one authority taking action that it considers appropriate in the area of another? I beg to move.

Lord Rooker:

My Lords, the Q& A section at the end of my brief contains an interesting point about mutual assistance schemes. I do not think that the noble Baroness was talking about mutual assistance schemes; she was almost talking about private enterprise schemes.

Baroness Hanham:

Predatory takeover, my Lords.

Lord Rooker:

My Lords, predatory action. The amendment is identical to that moved in Committee. We have read Hansard; there is clearly concern that there was cross-purpose in the discussion, for which I take full responsibility. Clearly, the noble Baroness's chief concern remains the ability of a fire and rescue authority to act outside its area under Clause 11.

Amendment No. 24 goes much wider and would prevent the fire and rescue authority preparing to respond to the risks and needs of its community as identified, for example, in its integrated risk management plan, because Amendment No. 24 explicitly links Clause 11(1)(b) to the exercise of functions placed on the authority by the order under Clause 9. That approach is unnecessary. An order made under Clause 9 provides a fire and rescue authority with the powers necessary to make provision to discharge the functions placed on it. That includes the power for the fire and rescue authority to act outside its area, so there is no obvious benefit to the operation of Clause 9 by the approach placed on the amendment.

The effect of Clause 11 would be diminished if the amendment were agreed. The purpose of Clause 11(1)(b) is to ensure that the fire and rescue authority can plan and prepare to respond to an event or situation. It is not a power to respond to the event or situation which is found in Clause 11(1)(a). But this power anticipates the need to meet future risks. It is crucial if the fire and rescue authorities are to be empowered to meet local need and to create safer communities. Amendment No. 24 would remove that flexibility and discretion.

In Committee, as today, the noble Baroness questioned the unrestrained ability of fire and rescue authorities to move into a neighbouring area and effectively set up business; that is, predatory, as the noble Baroness has just said. We do not share the noble Baroness's concerns about empire building which has—I have got to read this out—more than a touch of the regionalisation by stealth theory that remains ever popular on the Benches opposite.

This is not a surreptitious takeover. It is not another avenue for the Secretary of State to regionalise the whole country. There is no secret sub-plot for fire appliances to be sent out carrying ballot papers or new Bills for elected authorities. We have no plans for that. It is not regionalisation by stealth.

The Bill defines the statutory fire and rescue authority for an area and on whom rests the obligation to provide core functions. There is no argument about that from a legal point of view. There is nothing in Clause 11 that would override either this definition or the statutory responsibilities.

Clause 11 provides a fire and rescue authority—perhaps one specialising in rope rescue or another specialist activity—the authority to provide that service within another fire and rescue authority's area. I apologise, I cannot read this for laughing.

In view of the assurances that I have given about its operation, I hope that the noble Baroness will withdraw the amendment.

Baroness Hanham

My Lords, I hope that the Minister will give his notes to Hansard and that we can all enjoy the joke when we read it tomorrow. I shall be most inspired to know what is causing such hilarity. It is a long time since I have had the giggles. They are always started by one person, but they become infectious.

While we are all struggling with that, I do not think that I can do anything other than thank the Minister for his detailed reply—or his nearly-detailed reply. I am satisfied that the fire and rescue authorities will not be able to act in a predatory manner. I hope that by the time we reach Amendment No. 25, the Minister will have found another joke that we can also share. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Hanham

moved Amendment No. 25: After Clause 12, insert the following new clause—