HC Deb 28 November 2001 vol 375 cc294-301WH 12.30 pm
Hugh Robertson (Faversham and Mid-Kent)

I thank the Minister of State, Department of Health, the right hon. Member for Barrow and Furness (Mr. Hutton), for attending the debate. I am grateful for the fact that he will respond to my points, especially as the subject is not directly part of his brief. I also extend my thanks to his team of civil servants who, I know from contact with the Kent ambulance service at the weekend, have done a lot of preparatory work for the debate.

I have two reasons for wishing to secure this debate. The first, I confess, is entirely personal. I was born, educated and brought up in Kent; my parents, my fiancée and my in-laws all live in the county and, of course, I represent a constituency that is slap-bang in the middle of the county.

Secondly, and more important, there is genuine concern that the views of consultees, Members of Parliament, health service bodies, the ambulance service itself and my constituents—across the political spectrum, they all oppose the change—have not been properly represented by the regional office. I assure the Minister that I have had a continual involvement in the issue; it is not something that I just dreamed up this morning. I attended consultation meetings in August, made representations to the review, wrote to the Under-Secretary, the hon. Member for Salford (Ms Blears), and drafted an early-day motion on the subject a few weeks ago. I hope that this Adjournment debate marks the culmination of that effort.

Today I intend to talk briefly about the consultation process, discuss the aspects of the review that we welcome and support, highlight a few problems with it, and finish with some concluding remarks. The review process has taken more than three years, which is far too long. Critically, the reconfiguration was proposed by the south-east regional office in early 2000. "Modernising the NHS: Shifting the Balance of Power in the South East", the latest review, rendered that process obsolete.

Another problem is that the time the review has taken has had a serious effect on the Kent ambulance service, which is currently unable to recruit substantively to director positions, including that of chief executive; it has no human resources director in post at the moment. Despite the lengthy review process, there is no hard evidence that the proposed merger will have any financial or patient benefits. I am told that mergers audited elsewhere have not, in fact, secured those desirable benefits. As I have already said, there is no support anywhere in Kent from any of the key consultees for the merger. Finally, there is a worry that the disruption caused by the merger could put at risk many of the improvements in response time across Kent and Sussex. As a result, I am sure we all agree that patients and staff could suffer.

It is fair to say, however, that the review identified a number of benefits that we all support. The idea of a common ambulance vehicle procurement service is to be welcomed, as is the idea of a common communications system. The training and development of practitioners in emergency care—PEC—and the development of patient transport services are all welcome initiatives. I am pleased that there has been regional input in control and communications, clinical governance, human resources, procurement and fleet management. We whole-heartedly support all those things. Indeed, I should like to record my thanks for the Government's support for additional funding for the introduction of satellite navigation. Kent was one of the first ambulance services to install that navigation and it has already had considerable benefits.

However, there is a feeling that benefits could be achieved without the proposed merger. There are several reasons why we oppose the merger. First, and most important, ambulance services must operate to the same boundaries as strategic health authorities. "Modernising the NHS: Shifting the Balance of Power in the South East" said that there should be one strategic health authority for Kent. Everybody in Kent supports that sensible move. Strategic health authorities will have new responsibilities, including managing strategy and performance for NHS organisations within their boundaries. The review envisages that the NHS plan, the reform of emergency care and the review of ambulance services can be achieved only by co-operation between organisations. It follows that it is vital for patients, services and efficiency that the ambulance service operates to the same boundary as the new strategic health authority.

The Ambulance Service Association, responding to a request from the Minister for advice, said: Ambulance services should be aligned to one, or more, strategic health authorities—usually 1, sometimes 2 or more but never part of a strategic health authority". If the merger of the Kent and Sussex ambulance services goes ahead, the new service will end up servicing one and a half parts of the new strategic health authorities; that is the key objection to the merger. However, subsidiary factors also impact on the merger, including the fact that the structure of the NHS in Kent and throughout the country is changing rapidly. In my constituency, new strategic health authorities are in formation and a review of hospitals will undoubtedly result in the downgrading of the Kent and Canterbury hospital, whichever option is embraced; primary care trusts are being formed and there are changes to community health councils.

I feel strongly that few parts of the NHS are as vital as the ambulance service. It is much better to allow time for changes to bed in before we set about altering the structure of that vital service. The county of Kent is large enough to support its own ambulance service. The Ambulance Service Association, responding to a request from the Minister for advice on the reconfiguration of services, said: The minimum population served by Ambulance Services will be around 1.5 million. Kent has a population of 1.6 million, so it is large enough to support its own service.

Kent has particular needs because of its geographical position. It has an infrastructure like no other, comprising channel ports, the channel tunnel rail link, roll on/roll off ferries, the power station at Dungeness, and myriad motorways, including the M2, the M25, the M20 and the M26. The high-speed rail link is being installed and the county bears the brunt of all the traffic that comes across from the continent. With all that going on, there is a huge capacity for disaster for Kent, and many people in the county do not wish their ambulance service to be taken away.

Kent is a popular retirement county for elderly people. As the Minister will know, there are Government guidelines to build more houses. Its population will become more than 1.6 million, not less, which highlights the need to retain the ambulance service inside the county. There is also a political point: if the ambulance service is taken away, as local people see it, and merged with the Sussex service, many people in my constituency will feel badly neglected. As a result of the private finance initiative, they are already faced with the closure of the accident and emergency department at the Kent and Canterbury hospital, and are considering a series of options that will necessarily downgrade it. If, on top of that, they have to bear the loss of their county ambulance service, there will be a highly undesirable political impact.

I also oppose the merger because of costs. In a presentation this summer, the Kent ambulance service identified two types of cost: the initial investment and the transitional costs. They involved £1.6 million in pay equalisation, which I accept will probably happen, whatever the outcome of the review; £2.6 million of non-recurrent costs to cover, for example, staff redundancies, additional travel and relocation, IT upgrades and new signs; and a further £200,000 of recurrent costs every year. Whereas I welcome the £1.6 million to be spent on pay equalisation—it is quite wrong to discriminate against people just because they work in an ambulance service in Kent—the £2.6 million and the recurrent £200,000 could be better spent on investing in the services, not on relocation and reorganisation.

The final argument is what I call the 11 September argument. Following the disaster on 11 September, I am sure we all agree that it is important to maintain coterminosity with other emergency services in the county. The police and the fire service are already Kent-based, and the new strategic health authority will ensure that the health authority is also based in the county. When I spent a week during the summer looking at NHS facilities in my constituency, I was alarmed to discover that there is no common communications system between the ambulances and the police and fire services.

That cannot be good for emergency planning. The emergency services must be able to communicate with each other, and it is particularly important that they all work to the same boundaries. For the good of future disaster and civil emergency planning, I urge the Minister to leave the ambulance service operating to the same boundaries as other emergency services.

In conclusion, there are parts of the review which all of us welcome. However, a merger with Sussex is not necessary to bring about those benefits. There are major concerns in Kent, particularly about the lack of common boundaries with the strategic health authority should the proposals be implemented. That is the killer point.

There are also concerns about the amount of change going on in the NHS and the impact on people who work in the service; the unusually large size of Kent as a county—I believe that it is large enough to support its own ambulance service; Kent's geographical position and requirements, and its infrastructure; the perceived loss of NHS facilities following the closure of the accident and emergency department at the Kent and Canterbury hospital; the cost arguments—the £2.6 million and £200,000 recurring, which could be better spent on investment in existing services; and finally the need, after 11 September, to ensure that all our emergency services—the new strategic health authority, fire, police, ambulance and, in due course, I hope, the Territorial Army—operate to the same boundaries.

The proposed merger with Sussex has no support whatever in Kent. I take the opportunity this morning to urge the Minister to allow Kent, regardless of what happens elsewhere, to keep its own county-based ambulance service.

12.43 pm
The Minister of State, Department of Health (Mr. John Hutton)

I begin by expressing my gratitude to the hon. Member for Faversham and Mid-Kent (Hugh Robertson) for his kind words about my officials, who will have greatly appreciated his comments. It is not always transparently the case, but we are ready to help and I am grateful to the hon. Gentleman for acknowledging that.

I congratulate the hon. Gentleman on the way in which he raised the issues, and on the cogency and fluency of the arguments that he presented. He has done a signal job on behalf of his constituents. Outside this place and in the press—although that may not be the case today—Adjournment debates are often dismissed as unimportant and irrelevant; they are seen almost as a sideshow. I fundamentally disagree with that as they provide a forum for hon. Members to do what we are essentially here to do—to raise issues of concern and to confront Ministers when that is appropriate.

As the hon. Gentleman made clear, the provision of ambulance services in Kent is a critical issue which, as he rightly said, has been the subject of widespread debate across the county in recent months. I know that the hon. Gentleman himself has commented on the current proposals for change.

I am sure that the hon. Gentleman will understand that it is important that I do not prejudge or give the impression that I am prejudging the outcome of the consultation. Ministers will clearly need to approach the issues afresh and with an open mind, as they may need to make final decisions on the proposals. For that reason, I hope that the hon. Gentleman will forgive me if I do not engage in detailed debate with him about some of the specific points that he raised. I also hope that he will appreciate that I cannot make an announcement today on the way forward for ambulance service reconfiguration in the south-east.

I shall certainly reflect on the hon. Gentleman's concerns about the lack of common communications between the three emergency services. I do not have an immediate answer to that at my fingertips, but I shall write to him about his concerns, which I share and which need to be addressed.

I begin by referring to some of the arguments behind the proposals in the recent consultation, as it is important to put on record the background to the review. As the hon. Gentleman knows, in 1999 Sir William Wells, the then regional chairman in the south-east region, asked the ambulance trusts to review their structures to ascertain whether their number and size were appropriate to enable them to deliver best care for the 8.5 million people whom they serve.

The current seven ambulance services in the region worked together to create a joint vision of what they saw as their role in the future. The vision developed by the leaders of ambulance services in the south-east set out a number of important objectives that ambulance services in the region should achieve in the future. They should deliver the best care, according to individual patient's needs; give consistent, high-quality care based on evidence and best practice; make full use of new technologies to respond to patients' needs more quickly and effectively; ensure that staff are well trained and motivated, and have the skills that they need; and finally, collaborate across organisations to increase support for staff, improve the infrastructure and make best use of the resources available for patient care.

The public consultation on the proposals to reshape ambulance services in the region began, as the hon. Gentleman said, on 3 May 2001. Public meetings have been held within each of the existing ambulance trust boundaries. The hon. Gentleman will be aware that the consultation document put forward a preferred option of merging the seven existing ambulance trusts into three: Kent and Sussex, Hampshire and Surrey, and a new Four Counties trust covering Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire. The consultation document set out how ambulance services must continue to develop if they are to make the maximum contribution to a modern NHS.

I am sure that the hon. Gentleman would agree that those proposals should be set against a background of strong local identities in the south-east, which he described, As the consultation document states: People in the region require local, flexible and responsive ambulance services. These can only be provided by maintaining strong local identities and ensuring a close working relationship with other partners…including patients and carers". As the hon. Gentleman knows, the statutory period for consultation was extended by one month to take account of the moratorium on consultation exercises during the recent general election, and ended on 7 September.

I acknowledge that many strong and varied views were expressed during the consultation process. I take this opportunity to express my thanks to all hon. Members, the public and community health councils who submitted their views to the regional office during the consultation period. I can reassure the hon. Gentleman that all the views received are being taken carefully into consideration. I shall return to that. However, we must all recognise there is no single national blueprint for the configuration of ambulance services that will suit all localities, not least in the south-east.

Hugh Robertson

I appreciate that the Minister cannot prejudge the outcome of the review, but is it at least possible that the ambulance services which want to merge can do so, while those that do not can remain outside the review and retain a county-based service?

Mr. Hutton

That is a decision that Ministers may have to make. Trust reconfigurations and mergers are subject to ministerial approval. The hon. Gentleman invites me to pull Kent out of the reconfiguration proposals. Clearly, I cannot do that today, but it was a good try, none the less.

As the hon. Gentleman knows, the regional office is currently considering the responses that have been received which, I understand, will shortly be presented to Ministers. I reassure him that Ministers' decisions will be fully informed by the views that have emerged in the consultation exercise and that no recommendation will be agreed by Ministers unless we are wholly satisfied that it will provide the effective, high-quality service that the people of the south-east deserve and that we aim to provide to them.

In future, as the hon. Gentleman knows, Ministers will be advised about such proposed service reconfigurations by the independent reconfiguration panel, which will be chaired by Dr. Peter Barrett. The panel will start its work early in the new year. Its remit will be to assess proposals against clear criteria such as quality of care, community health needs, accessibility, patient safety and clinical and service quality. I hope that that will ensure that the outcome of these major health service reorganisations will be transparent and accountable and that those who are directly affected by the changes are fully engaged in the consultation process. As I am sure he knows, until such time as final recommendations on the reconfiguration of ambulance services in the south-east have been provided by the regional office and Ministers are asked to make a decision, I need to remain impartial about any final outcome.

In setting out his arguments for retaining a local ambulance service for the people of Kent, the hon. Gentleman rightly referred to the work of the Kent ambulance service. I am grateful to him for doing so. As he will know, the Kent Ambulance NHS trust was established in 1994. As he said, it serves a population of more than 1.5 million in both urban and rural areas and has more than 800 staff. It has 154 vehicles and last year handled about 97,000 emergency calls and 30,000 urgent calls. Dealing with those levels of demand is no easy task. I am sure that the hon. Gentleman will join me in taking this opportunity to thank everyone working in the Kent ambulance service for the tremendous work that they do day in, day out.

The Government's priority is to save more lives by providing faster, more responsive emergency ambulance services. Clinical evidence has proved beyond any doubt whatever that early defibrillation and resuscitation services can save more lives. That is why the Government set challenging response targets for all ambulance services as soon as we came into office in 1997. Since then, we have seen a range of improvements, to which the hon. Gentleman graciously referred. They include more staff and vehicles, faster activation, better matching of resources to demand, dynamic cover, as opposed to station-based cover—an important element in helping us to meet access and response times—effective relief levels and rotas, and flexible 999 responses.

We also recognised that ambulance service response times had to improve significantly. That is why we are committed to the target of responding to 75 per cent. of immediately life-threatening calls within eight minutes. That target is also a milestone in the national service framework for coronary heart disease. We have estimated that, if all services were to achieve the target, the lives of 1,800 more people suffering from heart attacks would be saved every year. I would be the first to admit that the target that we have set is challenging. As I said, however, response times save lives, and we are already beginning to see the benefits of service improvement.

Nowhere do we see that more clearly than in Kent, where the performance of ambulance services has improved dramatically during the past year. From a starting point of being able to respond to only 38 per cent. of life-threatening calls within the critical eight-minute period, they are fast approaching the national target of 75 per cent. I hope that they will be able to meet that target when the figures are confirmed later next year. That is a huge achievement and I should like to pay tribute to the staff at Kent Ambulance NHS trust for their hard work, especially during the unexpectedly high demand in the summer months. They are doing a fantastic job in difficult circumstances for the people of Kent.

Kent ambulance service currently has 24 rapid response staff and has established community responder schemes on the Isle of Sheppey and at the Bluewater shopping complex. In the coming months, the trust will look for further opportunities to extend those important new services. As well as developing new schemes around the country and in Kent, we have provided significant investment in all ambulance services. In March last year, we invested £21 million nationally to help ambulance trusts make progress towards achieving the 75 per cent. target by investing in extra vehicles and extra front-line staff. Kent ambulance service received £841,000 on a recurrent basis, which has enabled them to recruit an additional 30 front-line staff.

The Under-Secretary, my hon. Friend the Member for Salford (Ms Blears), also announced further investment of almost £3.5 million earlier this year. That funding enabled state-of-the-art satellite tracking and navigation systems to be fitted to all 3,000 emergency ambulance vehicles throughout the country, giving them accurate information on the location of callers. As the hon. Gentleman said, Kent ambulance services were the first in line for that funding and received more than £140,000 to assist them in making that investment.

Ensuring that we have a modern ambulance service that is integrated with other NHS and social care services is a fundamental objective in what we are trying to achieve. The investments that we have made will, hope, ensure that the service can respond to patients' needs more effectively and quickly, with well-trained and motivated staff providing consistently higher quality care. The supporting infrastructure will make maximum use of new technologies, delivering best value in order to help concentrate resources on patient care and to enable best practice to spread to all health communities more quickly. To support the integration of the ambulance service with other NHS and social care services, we announced additional investment of £50 million last month to implement the "Reforming Emergency Care" report.

As I have explained, I am, sadly, unable to respond now to some of the specific concerns the hon. Gentleman has raised and nor can I speculate on the outcome of the consultation exercise, although I hope that decisions can be made in the very near future. However, before I finish, I want to assure him once again that the arguments he has carefully set out will be given the most serious consideration, which they obviously deserve.

Mr. Nicholas Winterton (in the Chair)

We are grateful to the Minister for his reply All interested parties for the next debate are present, so we can begin early. The debate has been initiated by the hon. Member for North Warwickshire (Mr. O'Brien), but before I call him I should like to point out that he has had the courtesy to ask me and the Minister whether other colleagues who have interests in the subject of the debate can participate in it. My only comment is that I am very happy to call them, but I want the Minister to have adequate time to respond.