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Westminster Hall

Tuesday 24 April 2001

[Sir Alan Haselhurst in the Chair]

Hampshire Ambulance Service

Motion made, and Question proposed, That the sitting be now adjourned.--[Mr. Mike Hall.]

9.30 am

Sandra Gidley (Romsey): I am grateful for the opportunity to discuss issues surrounding Hampshire ambulance service. Although some of the examples that I shall cite give grave cause for concern, I have the greatest respect and admiration for those at the sharp end, who deliver the service every day under difficult conditions.

My interest in the local ambulance service was awakened not long after my election, when I was contacted by the clerk of Lockerley parish council. She described the tragic case of an elderly gentleman who had suffered a heart attack at home; an ambulance had been called. Hampshire's is a rural ambulance service, and the target then was that an ambulance should arrive within 19 minutes for 95 per cent. of calls. In this instance, the ambulance took over half an hour to arrive. It had been sent from Hythe, which is not local, as there was no nearer one available. The driver later admitted that he did not know where Lockerley was, and that he had come via Dunbridge because it was a village that he knew. He also said that, had someone not been waiting on the main road running through Lockerley Green to direct him to the property, he would not have been able to find it. There is no happy ending to this story. The patient died. We shall never know whether the early arrival of an ambulance would have made the crucial difference, but the situation of the delayed ambulance was stressful for everyone concerned.

Having spoken out on this issue, I was contacted by a number of concerned ambulance men. One letter said that it was

The figures bear out the increased work load. In 1995-96, there were 62,800 emergency calls. That figure had risen to 85,500 by 1999-2000--a 35 per cent.

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increase in four years. I am told that the work load has increased by 50 per cent. in six years, but I have not checked the figures.

Vehicle availability is down to 20 at night. That is an average of one ambulance per 75,000 population. The maximum varies daily from 41 to 43 between 3 pm and 5 pm and the overall average has dropped to 30.45. That might not sound like a huge drop, but set against the background of increasing work load, it shows a highly stretched service. These figures are for the whole of Hampshire and in each case the number is the maximum rostered. The figure is frequently not achieved because of sickness, holidays and training.

Many people are concerned about the fact that, at night, Southampton city has only two vehicles to cover a population of 220,000. There are ambulance stations at Bursledon, Eastleigh and Totton, but they have their own catchment areas to serve.

It would seem that, in addition to the problem in rural areas, towns and cities are not receiving a five-star service. I witnessed an example of that when I was out with the police in Eastleigh and an ambulance had to be called. It came from Whitchurch. There are six or seven ambulance stations closer to Eastleigh than Whitchurch.

In June the national response times were published. They made grim reading, and not only in Hampshire. Hampshire is regarded as a rural trust and has rural targets. That means that 50 per cent. of calls should be responded to within eight minutes and 95 per cent. within 19 minutes. I want to make it clear that those targets are for the whole of Hampshire. Many people think that shorter target times apply for built-up areas such as Southampton or Portsmouth, but I am afraid that that is not so. Anywhere in Hampshire is regarded as rural. Targets are exactly the same for the towns as for the villages.

Hampshire ambulance authority previously had a good record of achieving targets, but in the past year the percentage of responses made within eight minutes dropped to 44.5 per cent. and that for responses within 19 minutes dropped to 92.6 per cent. Both figures are well below the targets. However, to be fair to Hampshire, the performance of a majority of ambulance trusts declined sharply. The results are very worrying. I learned of other relevant incidents in the Lockerley area. On 11 May, an ambulance called at 2.30 am took one hour to arrive. On 18 May, an ambulance took 45 minutes to arrive. The crew admitted to getting lost.

I have met the chief executive and chief ambulance officer of Hampshire Ambulance, who have been frank and open. Various problems are apparent, but the basic one is underfunding. I have a letter from Richard Mawson, the chief ambulance officer, in which he refers to the funding discussions with health authorities with respect to 1999-2000. He states:

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The work load is hectic, which means that meal breaks are constantly interrupted, if they happen at all. The staff do not mind, but the system is now so tightly run that it is an everyday occurrence. No one appears to have undertaken a risk assessment to show the effects on performance of long hours without food. None of the staff members minds working extra hours, but many of them described a trend towards being called out increasingly often just before the end of a shift.

I spent a day with the Hampshire ambulance service and witnessed some of the problems at first hand. The pace was constant and we were lucky that nothing too horrific happened. However, one ambulance man said: "The problem is, if we have a death or something unpleasant, we are often straight on to the next job. Sometimes you just need a quiet quarter of an hour to help to come to terms with something. If you can't do that, the stress just builds up and there are an increasing number of personnel suffering from stress-related illnesses."

The ambulance men and women in Hampshire were also universally scathing about the new command and control system; the falling standards were partly attributed to it. It is worth mentioning some of their concerns. The system looks very good. The ambulances keep in touch with the control centre by means of a satellite navigation system. The computer operators in the control centre can in theory see at a glance which ambulance is closest to any emergency. Unfortunately, back in the ambulance, the system is not very high tech. The ambulance is informed of the address of the emergency and given a page number and rough grid reference, such as A4, from the appropriate Ordnance Survey map book. Once the ambulance is mobile, the navigator has to trace the journey by turning over pages of the book. There is no ambulance navigation system. I have used those OS books myself, and it is not easy to work out a long distance when one has to turn over a number of pages.

In addition, the crews are no longer in radio contact with one another. That might not sound like much of a problem, but it means that ambulance crews can no longer help each other out. Previously, there were frequent occasions when an ambulance crew could point out to control that its ambulance was better placed to respond to a call than that of the designated ambulance. The system does not always take into account problems such as one-way systems or motorway hold-ups. Also, if an ambulance is dispatched slightly off its usual patch, an ambulance man with local knowledge might be able to supply additional verbal directions, which could be the difference between life and death. Another aspect to the lack of communication is that, on occasion, a crew will have prior knowledge that a potential patient could be dangerous or abusive. They might even advise police

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back-up before entering a property. A way of communicating such information seems to be missing from the new system.

I witnessed some of the problems at first hand. On one occasion, the control centre thought that we were in Winchester, when we were in fact in Southampton. That was closely followed by my crew's returning to base, only to cross the path of an ambulance going to an emergency, travelling in the direction that we had just come from. We should have been directed to that emergency, but were not, and the crew's response was, "At least you have seen it for yourself now." I am glad to say that the trust has now acknowledged some of the issues relating to command and control and has spent time and money on further training for staff.

Other issues relate to a lack of consultation and frequent references to a top-heavy management structure. Recently, ambulances have been deployed to strategic points around the county in an attempt to improve response times. Theoretically that is a good idea, but the knock-on effect on the staff is that, in the rare event of a short break, they must sit in a cold, uncomfortable ambulance with no access to refreshment.

When I visited the ambulance station, staff were also somewhat demoralised because the response times had not then been published for some months. Conspiracy theories abounded, but the common response was, "The times must be really bad now; otherwise, they would be put up on the notice-board."

Mr. Philip Hammond (Runnymede and Weybridge): Will the hon. Lady clarify something that she said? At the outset of her remarks, I think that I heard her say that in rural areas a 14-minute response for category A was acceptable. Will she confirm that Hampshire Ambulance--a rural service--is targeting an eight-minute response time across the county?

Sandra Gidley : I think that I said that the response time was 19 minutes for a rural area for 95 per cent. of calls. The eight-minute response time is for the new core categorisation, which I shall clarify later.

There was a problem, because the new command and control centre was installed shortly before the ambulance service moved towards core prioritisation. That prioritisation means a change in targets, and I wholly support the Government's aim in establishing new targets. The new system means that calls are now categorised. Category A calls are emergency or life-threatening. The new standard requires that, by 2001, ambulance services should reach 75 per cent. of category A calls within eight minutes. Response times for other categories remain unchanged.

How is the Hampshire service doing now? In March 2001, the category A response figure for the county was 43.62 per cent. However, for the Southampton and South West Hampshire health authority, which covers the bulk of my constituency, it was only 37.94 per cent. Over the past month, there has been an improvement, and it is only fair to acknowledge that the movement is in the right direction. The latest figures are 53.6 per cent. for Hampshire as a whole and 48 per cent. for the Southampton and South West Hampshire health authority.

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The fact remains that those figures fall well short of the required target of 75 per cent. This year, Hampshire Ambulance has managed to secure the extra funding that it has been seeking for the past two years. A visit from the NHS executive team resulted in a confirmation that the working practices were not at fault, the case for additional funding was strong and the money should be found from the county's health budget.

Securing that funding has been a problem in the past, and has been something of a hit-and-miss affair. I have been told that the health authorities do not purchase to the targets. North and Mid Hampshire health authority is widely known to be undergoing financial difficulties, and in the past would have funded only 90 per cent. NHS trusts in Southampton and Portsmouth purchase services at a 95 per cent. level.

That leads me to some fundamental questions about the way that the nation's ambulance services are organised. Is it right that we use an arcane system of funding whereby the ambulance authorities have to go cap-in-hand to each of the health authorities in their area? Health authorities already have a hard enough time balancing budgets and setting priorities. It is simply not right that an ambulance service will not necessarily receive the amount of money that it requires.

There appears to be no nationally agreed formula for working out the desired level of ambulance provision for any area. There is a carefully worked out formula for fire service provision, so it seems logical that the same sort of exercise should be undertaken in respect of the ambulance service.

Dr. Peter Brand (Isle of Wight): Does my hon. Friend agree that, if we are to have a national formula, it should be funded? The Home Office has set a formula for the Isle of Wight fire brigade, but the standard spending assessment from the Department of the Environment, Transport and the Regions falls short of the Home Office figure by about £1.25 million.

Sandra Gidley : Yes, there should be funding to meet the identified need.

Just as there is no national standard for ambulance provision, it is regrettable that there appears to be no single body to which the disparate ambulance services are accountable. Currently, each ambulance service decides many of its own procedures and protocols. That means, for example, that if a patient who needs a tracheotomy keels over on the Hampshire-Wiltshire border, we must hope that the ambulance comes from Wiltshire, because Hampshire ambulance men are not permitted to carry out that procedure. Similarly, there are variations throughout the country in the types of drugs that paramedics are allowed to administer. Surely it is time to introduce a set of national guidelines on all those matters. It appears that there are no mechanisms in place for sharing practice and spreading best practice--something that is done well in other areas of the health service.

The question is how best to achieve that aim. Many of the staff to whom I have spoken believe that the ambulance service should be accountable to the Home Office and should work more closely with the fire service. I am not advocating that that step should be taken here and now, but more accountability should be

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demanded by the health service. In addition, ambulance men would like their conditions of service to be more closely allied to those of the police and fire services because they feel that they are a Cinderella emergency service--an expression that I have heard repeated many times.

To return to Lockerley, have things got any better during the past year? A letter from Frances Hanks, parish clerk of Lockerley parish council, to the director of operations at Hampshire ambulance service refers to an incident on 8 December when a woman

However, my main concern is that constituents who live in rural areas will always fall within the 25 per cent. of the population who can expect a response time of more than eight minutes. It is the responsibility of all of us to ensure that people are not penalised just because they happen to live in a rural area. It is simply not good enough to trot out the tired old argument that they choose to live there knowing the risks. We have a duty of care to everyone and should be providing that care.

Mr. David Chidgey (Eastleigh): Does my hon. Friend agree that plans to regionalise the ambulance service, so that there is one centre of control for most of the south-east, will only make the disparity between rural and urban areas greater? For example, if the county of Surrey were in the same organisation as Hampshire, there would be a gravitation of resources to the critical mass of the urban areas of Surrey at the expense of rural areas in Hampshire.

Sandra Gidley : That is a concern. I will address it later, but bigger does not necessarily mean better, and I remain unconvinced that that will be the case with ambulance services.

Mr. Hammond : The hon. Lady talked about her rural constituents always being in the 25 per cent. who would have a response time of longer than eight minutes. The

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Government's target is that, by 2003, 90 per cent. of category A calls will receive an ambulance within eight minutes.

Sandra Gidley : I was not aware of those targets; perhaps the Minister could clarify them, but I thought that the 95 per cent. target related to a 19-minute response time. I hope that I was wrong.

There are new problems associated with the measures that are being introduced to reach response targets, specifically with the use of rapid response vehicles. They are crewed by one person only, and the aim is for that paramedic to arrive within eight minutes--so that the targets are reached--to stabilise the patient. However, because a rapid response vehicle then requires the back-up of a fully manned ambulance, the system is heavy on staff. If it saves lives, every penny will be well spent. However, what assessments have been made of the various ways of dealing with emergencies? Are overall outcomes better when a paramedic rapidly arrives on the scene or when transport to hospital is regarded as a priority? Those are fundamental questions, to which I have as yet been unable to find the answers.

I ask those questions because of a recent highly publicised case in Havant, which illustrates the problem. A motor cyclist was injured and a paramedic arrived--17 minutes later, although that is not the point in this case. A fire crew were already there and had administered first aid, but the patient then lay waiting in the road for another 30 minutes as his condition deteriorated. All ambulances in the area were tied up, so the firefighters took the decision to transport the injured motor cyclist in the fire engine. Obviously, fire engines are not designed for patient transport, and one fireman had to kneel on all fours to support the stretcher on his back, while a second fireman sat on the floor to hold the stretcher and prevent it from moving. If that does not illustrate the fact that Hampshire ambulance services are overstretched, I do not know what will.

Hon. Members should not be lulled into a false sense of security by convincing themselves that that story was a one-off. I have been told of several incidents in which firefighters have ended up either driving an ambulance or attending to a patient in the back of one; such incidents are almost always as a result of a singly manned ambulance arriving at the scene. We all know that ambulances should have two ambulance men on board.

Coincidentally, I picked up a copy of the Andover Advertiser yesterday, which had the front-page headline, "Ambulance crisis looms". I notice that the right hon. Member for North-West Hampshire (Sir G. Young) is present, and I expect that he will want to elaborate on this. The first paragraphs of the story say:

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When I was out with the ambulance service, one incident brought home to me the fact that ambulances are sometimes called out for what can only be described as non-urgent reasons. A letter in the Romsey Advertiser from Liam Sizer, the southern area convenor of Unison, sums that up. It says:

I urge the Minister to consider running a public information campaign in a similar fashion to that aimed at dissuading people from calling out their general practitioner for trivial reasons. Abuse of the system costs money and lives.

The final item on the agenda is the proposed merger of the Hampshire and Surrey ambulance trusts--mentioned hon. Friend the Member for Eastleigh (Mr. Chidgey)--which will shortly go out to public consultation. To show my linguistic roots for a moment, let me say that the merger strikes me as a completely barmpot idea if ever there was one. I have not seen the final consultation document, but the following points need to be addressed.

Bigger is not necessarily better, but often results in an extra tier of management. Cynics have pointed out that, before the merger's announcement, the Hampshire ambulance trust board mysteriously increased in size and most new appointees were people who had recently retired only to return suddenly. Many people regard that as a cynical ploy to appear to be cutting jobs when, in reality, a few jobs were created for a short period to provide a cushion. The reality is that most long-serving people will keep their jobs under the new scheme.

Change is disruptive. Hampshire is experiencing problems in trying to get to grips with the new control system and is still nowhere near achieving the targets. Further disruption will result only in a worsening of response times in the short term, with no guarantee of an improvement in the long term.

Many people in the ambulance service regard the merger as a done deal, because it has been said that the status quo is not an option. Although I am here today highlighting problems with the status quo, I am still not convinced that there are any advantages to the merger. Surrey and Hampshire are not natural partners. Hampshire looks more readily to Dorset and Wiltshire, but those counties are now officially in the south-west, so we cannot consider a merger with a more like-minded county. The huge problem is that Surrey is an urban trust with urban response targets, but, as has been mentioned, Hampshire is rural; so what targets will the new trust have? I am sure that Surrey will not settle for a diminution in service, but it will cost a considerable

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amount of money to bring Hampshire up to Surrey's standards. Hampshire is not even meeting its own standards at the moment, so heaven help us if we have to achieve higher standards.

In addition, reorganisations cost money. Who will pay for reorganisation? Hampshire secured extra funding this year only because it demonstrated that there was an operational need for it, but that need does not cover the likely costs of reorganisation. Why is the merger proposed when Operational Research into the Health Service conducted a survey two years ago on the regional office's behalf and concluded that there would be no benefits in a merger? There will also be pay differentials, as the two trusts are paid differently. I do not believe that recruitment and retention will be improved.

If the Minister is minded to consult on the scheme, I ask that the consultation be real and, if opinion is against it, for her to take note of that. Will she also make clear the cost to the public purse of the proposed administrative upheaval?

The speech that I have made today may sound somewhat negative. Most people who call for an ambulance get one quickly, but the problems that I have highlighted show that the system is under considerable strain. There needs to be serious consideration of Hampshire Ambulance Service NHS trust and other trusts to try to sort out some of those problems.

It would help if we had a set of national standards and guidelines that were matched by funding that automatically meant that those standards were attained. Clear accountability is also needed, because one thing that I have noticed in all this is that no one seems to have put their hand up and said, "It's our fault."

9.59 am

Sir George Young (North-West Hampshire): The House is grateful to the hon. Member for Romsey (Sandra Gidley) for the opportunity to debate the ambulance service in Hampshire. As she says, it is a topical matter in my constituency. Last week's edition of the Andover Advertiser, the voice of Andover, led with the story to which she referred. She quoted extracts from Caroline Inman's report, in which a fire brigade representative said:

I visited the Andover ambulance station in my constituency, the command and control centre in Winchester, and NHS Direct, which I understand is run by the ambulance service. Like the hon. Lady, I have a high opinion of those who are at the sharp end as well as those who are providing back-up services, those who are managing the command and control centre and those who are trying to run the service.

The debate that the hon. Lady initiated is symptomatic of a broader debate, which confuses my constituents and should worry the Government. We are coming to the end of a Parliament in which the health service has been a Government priority. We have all seen the NHS plan that was published last July, and we have seen the Prime Minister on the Frost programme,

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promising more resources. Many of us were in the House last November when the Secretary of State made a statement about more resources for the NHS. Yet the rhetoric does not match the reality of the everyday experience of my constituents.

The hon. Lady mentioned some worrying incidents. The delays for out-patients are now worse than they were. For example, in the third quarter of 2000, 1,058 out-patients were waiting 26 weeks or more, which was up from 548 a couple of years earlier. People are waiting for wheelchairs. Someone waiting for a wheelchair in my constituency may receive a letter from the Winchester and Eastleigh NHS trust that states:

The hon. Lady mentioned the resources that are available to the Hampshire ambulance service trust, and I want to focus on that for a moment. As she said, the trust receives resources from the three authorities for the area--the North and Mid Hampshire NHS health authority is the one for my constituency--which are resourced according to a formula. In my view, the formula is unfair. The NHS ambulance service in Hampshire is under pressure because the resources for the county as a whole are less than they should be. For every £100 of NHS resources allocated nationally, my constituents receive £80. We are deemed to be 20 per cent. healthier than the rest of the country. I do not believe that that is the case. Not all deprived people live in deprived areas. More than half of the most deprived individuals in the country live outside the most deprived 20 per cent. of wards. Any resource allocation to health authorities and ambulance services that targets only the most deprived wards will miss more than half of the most deprived people.

In April last year, the Minister set up a panel to scrutinise a document entitled "Meeting the Challenges", which was about funding for Hampshire health authorities. The panel was appointed to examine proposals aimed at achieving savings of £13 million in the health service in Hampshire. That panel said of the formula that funds the Hampshire ambulance service that

The formula is being looked at, but over a rather leisurely time scale and there is no prospect of imminent help for Hampshire, which needs a more equitable distribution of resources. That shortage of resources is

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at the heart of some of the issues raised by the hon. Member for Romsey. In a letter dated 20 July 2000, the chief ambulance officer wrote:

That matter worries the Winchester and Central Hampshire community health council. General practitioners in my area have also raised the question of the ambulance service not arriving within the response time targets. There are possible plans to centralise paediatric intensive care at Southampton hospital. That may make good medical sense, but it will put a lot of pressure on the ambulance service to transfer those vulnerable babies. The CHC and the local MPs will keep an eye on that as it will mean an increased demand for the ambulance service and more funding will be needed if that is to be secured.

Mr. Hammond : I am sure that my right hon. Friend would want to note that the CHC will keep an eye on it for as long as it can, given that the Government are committed to abolishing it.

Sir George Young : My hon. Friend brings me back to our debates in the Committee stage of the Health and Social Care Bill. I hope that the House will soon have an opportunity to revisit that. I hope that the CHCs can continue to scrutinise the delivery of health care in Hampshire for some time to come.

When I visited the control and command centre at Winchester I learned that it was settling down but that it had had one or two teething problems, which may be behind some of the incidents that we have heard about today. It would be helpful if the Minister could give us a clear statement about where we are on reorganisation. It has been a diversion of management effort over the past few years to have the future of the ambulance trust put into question. There has been a lot of turbulence in Hampshire with the abolition of some trusts and mergers of others. I hope that the Minister will not go ahead unless she is convinced that this will directly alleviate some of the problems that have been mentioned this morning.

There is one issue on which the Minister may be able to shed some light. I understand that, in some parts of the country, the ambulances are no longer based at the ambulance stations but are sent to outposts in various parts of their area where it is felt that accidents are likely to happen. I can see that that would reduce the response time, but in my constituency ambulances are posted to a junction of the A303 and the A34. That may indeed be an accident site, but we have only two ambulances on duty and if one is permanently stationed at that junction it leaves the citizens of Andover rather exposed. Is there any Government guidance on how ambulances should be positioned?

I know that the Minister she will refer to the huge extra sum of money that she asserts has been made available to the health authority. When headline national increases of 8.5 per cent. were announced last November, I wrote to my health authority to find out the reality. Unsurprisingly, its perception was not quite as rosy as that of the Minister. In his reply, the director of finance at the health authority said:

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Some of the increase is ring-fenced to meet targets set by Ministers. If the ring-fenced and other money is deducted, it will be impossible significantly to improve the service. The penultimate sentence of the director of finance's letter says:

Will the Minister make clear whether the reorganisation of the health service in Hampshire will lead to further turbulence? What progress is likely to be made on reviewing the funding formula, which lies at the heart of the issues raised in this morning's debate?

10.10 am

Mr. Peter Viggers (Gosport): I am grateful for the opportunity to speak briefly in this important debate on the Hampshire ambulance service. I recall the days of the original arrangements for the service in my Gosport constituency. Two ambulances based at the Bury Cross depot were responsible for transporting patients to and from the local hospitals and for undertaking transfers for out-patients. It was a locally based service that was well received. I had few complaints and I would like to add my tribute to the ambulance workers who undertook those services then and now. No one enters the ambulance service without a sense of vocation, which I discovered whenever I talked to ambulance workers in my constituency or in Hampshire generally.

The old arrangements could not continue into our modern, high-tech age. The new arrangements described today are now organised at the command and control centre in Winchester. They are intended to be much more efficient, but worrying teething difficulties have occurred. I recall a constituent telling me that an ambulance was called for her husband who had suffered a heart attack. It came not from Gosport, but from Hayling island, some distance from the constituency. The ambulance was delayed and, because the driver did not know the route into Gosport, the patient's wife had

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to talk him through it. The patient's daughter was sent out into the road with a torch to guide the ambulance in. Unfortunately, the patient died.

That is not the only case. The reorganisation and restructuring has meant that ambulances have had to come into my constituency from a considerable distance away and, because the drivers and crew do not know their way around the area, unacceptable delays have occurred. We must all hope and trust that the new system described by the hon. Member for Romsey (Sandra Gidley) and by my right hon. Friend the Member for North-West Hampshire (Sir G. Young)--the high-tech control and satellite navigation systems and the upgrading at Winchester--will produce a more efficient system in the longer term. I am grateful to the Hampshire ambulance service for providing one extra ambulance in the Gosport area to take account of the extra demand.

I shall not repeat points already well made by the hon. Lady and my right hon. Friend, but I want to raise two further issues based on my experience of dealing with the Hampshire ambulance service and local circumstances in my constituency.

The Government have been slow to keep the Hampshire ambulance service abreast of developments in merger discussions and changed funding systems. The Government were slow and unresponsive to local concerns. It took two years for the ambulance service to clarify the Government's thinking on the proposed merger and refunding. Members of Parliament should not have to intervene in such discussions. I pay tribute to the Minister; I raised an issue with her in the House after a Division, which her office followed through. I am grateful for that first-class response. However, there seems to have been fuzziness in the lines of communication between the Minister's Department and the Hampshire ambulance service, which I hope can be clarified.

My constituents would not forgive me if I did not make the point that the range of difficulties created in the Gosport peninsula and south Hampshire have been seriously worsened by the Government's announcement that they propose to close the Haslar hospital in Gosport. It was originally announced that the closure would not take place before 2002, but its accident and emergency unit has already closed. We have fought the closure with absolute determination; 22,000 people came on the march in January 1999, which is thought to be the largest march in protest against a hospital closure. Because of our fight, the closure will not take place before 2007, or even later. The private finance initiative bid for Queen Alexandra hospital, which would enable it to take on much of Haslar's work load, has again been delayed. We therefore feel confident that we are winning our campaign. The number of out-patients who can be seen at Haslar hospital is to be increased from 55,000 to 60,000; Haslar also has an accident treatment centre. However, that does not diminish the fact that the closure of its accident and emergency unit has made life much more difficult for the ambulance service in the area. Ambulances now regularly have to mix with the tidal flow of traffic out of Gosport in the morning and back into the town in the evening. If the Government rethink their plans on Haslar--as they must--the pressure on the ambulance service will eventually

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decrease, to enable it to provide a better service for the people of south Hampshire. We will continue the campaign on that issue.

I pay tribute to the hon. Member for Romsey for raising the debate and to my right hon. Friend the Member for North-West Hampshire for his informed contribution to the discussion. I add a plea that reorganisation and turbulence be diminished and that those responsible for the ambulance service in Hampshire be given the funding and the decision-making capacity that will enable them to continue to carry out their work.

10.18 am

Dr. Peter Brand (Isle of Wight): I congratulate my hon. Friend the Member for Romsey (Sandra Gidley) on initiating the debate. We all expect the ambulance service to be in place; we value it when we need it, but forget about it for the rest of the time. That is a tremendous mistake. As a practising doctor who does the odd bit of emergency cover, I am always more relieved than even the patient to have the support of a professional ambulance crew. The service has developed its role over the past 20 or 30 years in an amazing way and has a fantastic standard of training. As has been highlighted in the debate, extra stress is being put on the professionalism of a group of people who want to deliver a good service--I do not know a single ambulance man or ambulance woman who is not dedicated to that task.

Some of the organisational problems suffered by Hampshire may affect the services on the Isle of Wight. Having made a more general point about the conditions under which we expect ambulance personnel to work, I would also argue that those personnel are undervalued. It is partly a matter of wages, but it is also a matter of working conditions.

The right hon. Member for North-West Hampshire (Sir G. Young) mentioned the strange practice of putting ambulance personnel on standby in car parks. I would like to know whether that has made a difference to response time and the survival rates of patients. It certainly makes an enormous difference to the way in which ambulance personnel are valued. Proposals to close the ambulance station in Ryde--the second largest town in my constituency--and to base the ambulance personnel in a car park somewhere on the downs cannot be right for the working conditions for those involved.

I would also urge the Government to reconsider the ambulance services' request for better and more appropriate protective clothing. Luckily, the risk of involvement in stabbing incidents is not high in Hampshire, but difficulties can arise where there is alcohol and disruption. If individual ambulance personnel would like the protection of lightweight, protective clothing, it should be made available. Financial considerations should not interfere with that.

Much was said about the loss of local knowledge among ambulance personnel. I would like to touch on that, because we have had experience of what happens when one tries to be efficient and amalgamate services to create a larger unit. We have seen it in the case of NHS Direct--it takes about 10 minutes to get through to the service, another 10 minutes to set out the story and then it often takes another 10 minutes to find the appropriate

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person to deal with the patient's problem. Unfortunately, quite frequently the message that comes back from NHS Direct via the ambulance service to the doctor on call is incomplete. On two occasions, NHS Direct has not passed on to me telephone contact numbers for patients. It is essential to have a way of communicating with people. Such failures create duplication and delay.

In our region, we also have experienced the centralisation of the police control room at Netley. As far as the Isle of Wight is concerned, it has been a disaster. People are not sure whether they should be dialling 999 or getting in touch with the police control room. Those working in the police control room take an enormous amount of time to pick up the phone, and they often say, "This is not an emergency for us, ring your local police station tomorrow," not knowing that that local police station is not manned, and leaving people to deal with an answerphone. I would not want that sort of pattern to be repeated in the health service.

There is evidence that, when organisations get bigger, although that may result in efficient systems that can be tracked, people get lost in them. Before decisions are made on regional amalgamations, especially in respect of the ambulance personnel control room, I hope that the Minister will wait to see what the Audit Commission says about NHS Direct, to see whether that kind of regional structure is the most appropriate. She should also speak to those who are experiencing the effects of centralisation in the police control service.

Mr. Hammond : The hon. Member for Romsey (Sandra Gidley) raised two issues relating to organisational structure: whether ambulance services should be placed under the control and responsibility of the Home Office, and what the services' relationship with the fire brigade should be. The hon. Lady stressed that she was not advocating any particular course of action with respect to those issues. As official health spokesman for his party, can the hon. Gentleman tell us what his party's position is on those issues?

Dr. Brand : I am grateful for that question, because I believe that the ambulance service should be an integral part of the national health service. We also believe that the NHS should be an integral part of local democracy, as should the police and fire services. The ambulance service should work with local doctors who work out of hours and with local casualty departments, so that local flow patterns can be established.

The important point that the hon. Gentleman is making is that the emergency services must work together. I have been disappointed that successive Governments have tried to improve efficiency by making the control systems and units of the ambulance service, police and the fire brigade bigger, but retaining their isolation. That may produce a regional fire brigade, ambulance and police service, but we need an integrated emergency service, which could also include civil defence and out-of-hours social services provision. In that way, each locality could provide an appropriate response to an emergency. That would eradicate some of the problems that have been highlighted during the debate, such as that of people who inappropriately

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contact the ambulance service. We cannot blame people for doing that if they do not know whom they should contact. NHS Direct should be able to cope with that problem, but, in my experience, it does not always get it right. I hope that it will do so in time.

It would be much better if local services were integrated. Hampshire is almost too big for that, but the health authority areas should be able to integrate some of their services. Some services would need to be town or city based, whereas others are obviously more rural. There are different response requirements in different places. Rural areas tend to be more self-sufficient. That does not mean that they should not receive a five-star service, as my hon. Friend the Member for Romsey said, but local general practitioners are often more responsive to out-of-hours work and there is more collaboration between the ambulance service, medical and even pharmaceutical services in rural areas.

This is a valuable debate, which is not only about Hampshire, but about how the Government see the interaction between the people who need the emergency services and those who provide them. I hope that they will not take the bean-counting route of "bigger is better" and look only to make efficiency savings in the cost of telephone operators, but that they will have regard to the quality of service that will result from the structures that they are considering.

I would be horrified if ambulance services on the Isle of Wight were forced to amalgamate with those in Hampshire because amalgamation of the police service has not been good for us. There is a risk that we will do just as badly from an amalgamation of the fire brigades, and I believe that amalgamation of the ambulance services would be a disaster.

10.28 am

Mr. Philip Hammond (Runnymede and Weybridge): I, too, congratulate the hon. Member for Romsey (Sandra Gidley) on securing the debate. Like accident and emergency services, ambulance services are a matter of great concern to all our constituents and strike at the heart of the population's confidence in the service provided by the national health service. We must keep our ambulance services under constant scrutiny. Indeed, a couple of months ago, the Minister replied to a debate that focused on ambulance services in London, but in which some wider issues were raised. Some of those issues have been raised again today, and I hope that the Minister has some more general comments to make when she winds up the debate.

My hon. Friend the Member for New Forest, West (Mr. Swayne) would have liked to attend the debate but, unfortunately, he is detained by the Special Standing Committee that is considering the Adoption and Children Bill, so I am here instead. I thank my right hon. Friend the Member for North-West Hampshire (Sir G. Young) and my hon. Friend the Member for Gosport (Mr. Viggers) for their lucid and well-informed contributions to the debate.

My right hon. Friend focused on ambulance trusts and their funding, paying particular attention to the Hampshire ambulance trust, in the context of the other pressures on health authorities. We must always remember that the Government, who exhort and set targets, set them by the score. There are other pressures

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on the limited purses that are the responsibility of the people who determine the funding of the ambulance trusts. Rightly or wrongly, the perception of my right hon. Friend's constituents, like that of my constituents in Surrey and those elsewhere in south-east England, is that funding formulas do not take into account the additional cost pressures on health providers in the relevant areas and that they underestimate the pockets of deprivation in areas that are relatively affluent overall.

I was grateful to my right hon. Friend for raising the issue of community health councils and their important role in scrutinising ambulance services' performance. The Government are committed to the abolition of community health councils--a decision that all the Opposition parties in this Parliament oppose and will continue to fight. The example of CHC involvement in monitoring ambulance services is interesting because it reveals a particular weakness in the Government's proposals to replace CHCs with patients forums.

Under the Government proposal, a patients forum will of course be associated with the Hampshire Ambulance Service NHS trust. However, ambulance trusts cover wide areas--a whole county in Hampshire's case, but even larger areas for some trusts. It is difficult to see how a countywide monitoring body, or one that is multi-countywide, will provide the focused scrutiny that CHCs have been able to give. That is another reason to add to the catalogue of reasons for the Government to reconsider their decision to abolish community health councils.

I was grateful to my hon. Friend the Member for Gosport for highlighting the difficulties of communication that seem to have occurred during the progress of talks about funding, and, in particular, the merger proposals affecting Hampshire ambulance service. The point is important and it goes to the heart of some of the questions about morale, recruitment and retention.

My hon. Friend also made an important point that I had not heard before, in drawing attention to the effect of the apparently inexorable process of consolidation of hospital services into ever-larger units. That process is driven not just by economics but by the royal colleges' concerns about patient safety and the need for minimum levels of throughput for procedures to maintain safe practices. Such consolidation will affect the need for ambulance services. It is obvious that, as hospital services are provided in ever-larger units and patients must travel increasing distances to use them, ambulance services will have to expand faster than the health service overall.

Dr. Brand : Does the hon. Gentleman agree that the process will not have an even impact across the country? Some areas will be much more affected by that desirable way of providing services in certain fields of expertise. Some isolated rural and island areas will be very much disadvantaged.

Mr. Hammond : The hon. Gentleman is obviously right to say that the phenomenon is not evenly distributed, but it is still important. It is perhaps related to another point, made by the hon. Member for Romsey. She asked whether ambulances are considered

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primarily as a mode of transport to hospital, or as mobile treatment areas in which treatment is begun where the patient is picked up. That is part of the broader issue of how we create proper paramedic and ambulance services in a world where the distribution of hospitals and specialist care centres is different from that of 10 years ago.

Sandra Gidley : Does the hon. Gentleman agree that as part of the "re-look" at the ambulance services we should consider the fact that ambulances are far too often used as an up-market means of transporting an old lady from one hospital to another, when there is probably no need for a trained paramedic and a back-up person? Is there not a case for a total review of the services provided by the ambulance service to identify more clearly the calls that need to be responded to by paramedics? Should we not also consider increasing the transportation side of the ambulance service in another manner? At the moment, all these services tend to be put into one big pot.

Mr. Hammond : The hon. Lady is right. The services should not be treated as being in one big pot. To be fair, many ambulance services separated their patient transport services--and they are now covered by separate contracts. However, she raises an important point. I hope that the Minister will say more about it.

I am confused about whether ambulances should get patients to hospital as quickly as possible or begin treatment at the scene. I have seen data that send conflicting signals about which approach gives patients the best chance of survival and recovery. It would be interesting if the Minister could update us about current thinking, and tell us what the indicators are from the latest available data and how she therefore expects ambulance services to develop. I suspect that the consolidation of hospitals into ever-larger units--certainly for specialist treatment--will continue. That is key to establishing patient confidence in the service.

People are conscious of where their nearest hospital is. However, anyone who looks into how the system works will quickly become aware that a patient is not necessarily taken to the nearest hospital. To use a Hampshire example, a patient suffering a head injury following a motor accident in Winchester will not be taken to the hospital in Winchester; he will be taken past its door to the hospital in Southampton because that is where head injuries can more properly and appropriately be dealt with. The matter is more complex than locating the nearest hospital and thinking of ambulances as a means of getting from A to B. Perhaps we have to take one step backwards in order to take two forward in thinking about the future configuration of ambulance services.

The hon. Member for Romsey has highlighted specific factors and issues relating to Hampshire, but in the process has touched on broader issues that relate to a much wider area. One such matter is the rationalisation and regionalisation of services in the south-east and the debate about the merger and reorganisation plans for ambulance services in the region, particularly the possibility of merger between the Surrey and Hampshire ambulance services. My right hon. Friend the Member for North-West Hampshire asked the Minister about that. I, too, should be grateful if she would tell us the current state of play.

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My perception, as a Surrey Member of Parliament, is that Surrey is different from Hampshire in that its northern and eastern fringes are of a much more urban character. Its problems are more akin to those of the London ambulance service than to those of a rural one. Having said that, there is a degree of co-operation between Surrey and Hampshire ambulance services.

My hon. Friend the Member for Aldershot (Mr. Howarth) was in the Chamber earlier in the debate. He is not essentially involved in the discussion over Hampshire ambulance services. In his constituency, the majority of ambulance cover is provided by Surrey ambulance services under arrangements between the relevant health authorities. My hon. Friend believes that the arrangement works well.

Reference was made to the introduction of new technology for the Hampshire ambulance service. New technology often leads to teething troubles, but it is necessary to provide a modern ambulance service. It was, however, rather late coming to Hampshire, largely as a result of underfunding. Over the past two years, the Hampshire service has received only inflation-based increases, but demand--measured by the number of calls on the service--has risen by 8 per cent.

The Government set targets for the delivery of ambulance services and some money is passported through directly for the modernisation of ambulance services. The majority of the funding, however, comes from health authorities that face other huge pressures on their budgets. The health authorities that fund Hampshire Ambulance provide between 90 and 95 per cent. of the resources necessary to deliver the service. It is incumbent on the Government, when presenting and reiterating target figures, to address that issue. It is no good constantly reasserting the targets when adequate funding to meet them is clearly unavailable under current mechanisms.

Below-target response times are a widespread problem, but our debate on the issue has been confused. I shall clarify my understanding of the position and the Minister can correct me if I am wrong. Under the patients charter, the target for April 2003 is that for category A, life-threatening calls, an ambulance must arrive at the scene within eight minutes in 90 per cent. of cases. That information is set out in a bulletin from a website, which has just been printed out for me during our debate. That is my understanding of the Government's ultimate target. I assume that 75 per cent. is an interim target for April 2001.

The most recent published figures demonstrate that by April 2000, all ambulance trusts bar one--Staffordshire--failed to meet the 75 per cent. target. Another year has passed and the figures will not be published until June, but I hope that the Minister can provide some information about the percentage of ambulance trusts currently meeting the 75 per cent. eight-minute target.

I am not optimistic. The direction of travel has been backwards, not forwards. As I said, only Staffordshire had met the target by April 2000, and even that was a static performance in relation to the previous year. Several others in the list--Sussex, Dorset, Two Shires,

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Kent, Bedfordshire, Hertfordshire, Isle of Wight, Oxfordshire, Gloucestershire, Hereford and Worcestershire and West Country ambulance services--actually went backwards. Hampshire went from a 52.8 per cent. response performance in 1998-99 to 44.5 per cent. in 1999-2000. The Minister told us today that, by March 2001, it had fallen further to 43.62 per cent. To what does the Minister attribute that dismal decline in ambulance service performance? Why has her Government allowed the service to deteriorate to that level when, for example, in the last year of the previous Government, Hampshire ambulance service was achieving a 53.2 per cent. eight-minute response? Given the figures, will the Minister revise the targets for 2003 downwards to reflect reality or will she, as the Government have done with their other targets in the NHS plan, simply ignore what is happening in the real world and continue to spin the target figures, as though they were an achievable reality?

As the right hon. Member for Holborn and St. Pancras (Mr. Dobson), the former Secretary of State for Health, said, the Government

10.46 am

The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart) : I congratulate the hon. Member for Romsey (Sandra Gidley) on securing the debate. I note that she has visited the ambulances, as have many other hon. Members present. I sometimes wonder whether ambulances are the most visited part of the national health service. That is a tribute to them. We all engage in their services considerably. I am aware of the hon. Lady's interest in the NHS ambulance service and this is a timely debate on ambulances, not just in Hampshire, but across the country.

Hampshire Ambulance Service NHS trust provides services for the residents of three health authorities that cover the Hampshire area: North and Mid Hampshire, Southampton and South West Hampshire, and the Isle of Wight, Portsmouth and South East Hampshire. The trust covers an area of some 1,400 square miles and provides emergency and non-emergency services for around 1.5 million people. In addition to the urban and congested areas of Portsmouth and Southampton, it has some rural and sparsely populated areas including the New Forest. The trust has nearly 500 staff, 68 emergency ambulances and eight fast-response vehicles, and last year it handled around 86,000 emergency calls.

I am sure that the hon. Member for Runnymede and Weybridge (Mr. Hammond) will join me in taking the opportunity to thank all the staff of the Hampshire ambulance services for the tremendous work that they do, day in, day out. The hon. Member for Isle of Wight (Dr. Brand) was right to say that because of their reliability, we tend to be grateful on the days that we need them but there is a danger that we may forget their daily work. I want to reassure ambulance services

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everywhere that they are not forgotten. I hope that the extra investment and the development work in their role and function over the last few years will reassure ambulance services everywhere that, although formerly they could justifiably have been described as the forgotten service, that is not the case now. They play a vital role as part of the NHS family.

I was grateful that other hon. Members reiterated that, while it is an emergency service, the ambulance service is seen as an integral part of the NHS family and should remain so. The value of the work of Hampshire ambulance service is abundantly clear from the way that it has provided medical care in times of need such as the recent major chemical fire in Portsmouth. The Government have given a high priority to improving emergency response times to those patients who are severely ill or injured. Anyone reading the national service framework for coronary heart disease or the NHS plan will see just how much emphasis has been placed on the need for improved response time standards.

The hon. Member for Runnymede and Weybridge highlighted the function of ambulances. The question whether a patient should be just transported or receive immediate care varies, depending on the circumstances. We must get away from seeing the ambulance service as people carriers. They are highly trained paramedics who can fulfil important functions.

Mr. Hammond : I am not trying to make a political point, but I have seen data that have thrown into question the hypothesis that treating trauma patients at the scene and thus delaying their admission to hospital improves the outcomes for those patients. Does the Minister acknowledge that that is a genuine issue of concern, which should be investigated?

Ms Stuart : I certainly do, and I recently had discussions with trauma surgeons about the best way forward. However, for patients with cardiac arrest, there is no doubt that the quicker a paramedic arrives at the scene, the better. Even more to the point, we are investing heavily to provide defibrillators in public places--some 700, at a cost of £2 million--because the help that they provide does not require the presence of a paramedic.

I should like to resolve some of the confusion about the challenging national targets that we have set. Our expectation is that all ambulance services should respond to life-threatening emergency calls, which are generally known as category A calls, within eight minutes 75 per cent. of the time, irrespective of location. That target should be reached, whether the call is in the centre of London or in the most rural area. We must find ways to achieve it. I do not accept the argument that we cannot because there is a big difference between rural and urban areas. The solutions for meeting our expectations will be different in different areas.

Sandra Gidley : Will the Minister give way?

Ms Stuart : If I might make a little progress, many of the questions will be answered.

I would like to see the website that says that the Government have set a target of 90 per cent. by 2003. I am not aware of such a target. Officially, we have said

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that we want every service to reach the 75 per cent. target first, and then we will move on from there. That is important.

We want to ensure that ambulance services everywhere get to more patients in time to make a difference. That is not about creating league tables but about saving more lives. Clinical evidence shows that faster resuscitation, quicker heart shocks using a defibrillator, and the earlier delivery of clot-busting thrombolytic drugs can all make an important contribution to the effort to reach the demanding targets that we have set for saving more lives.

Since 1997, ambulance services have improved their response times by using a range of measures, including more staff and vehicles, faster activation, better matching of resources to demand, dynamic as opposed to station-based cover, effective relief levels and rotas, and flexible 999 responses. I emphasise the issue of where ambulances should be located. The ultimate aim is to get effective help to immediately life-threatening category A calls within eight minutes.

Developing new ways of fighting the war against heart attacks is very important, especially in the more rural areas where ambulance responses tend to take longer. First responder and community volunteer responder schemes buy time during the vital first minutes and until a fully equipped and crewed emergency ambulance arrives. In some areas, first responders work with the fire service. That is right and proper; the aim is to get people there quickly.

Across the country, NHS ambulance trusts answer and respond to more calls year on year. In the past five years alone, emergency 999 calls have risen by nearly 1 million--an increase of 30 per cent.--and the number of patient journeys has also increased.

Dr. Brand : I am fascinated by the Minister's comment that it is policy to allow the other emergency services to provide a service. I am totally in favour of that. However, will she speak to her colleagues in the Home Office who base fire brigade funding entirely on callouts to fires and do not consider any accident or emergency service that they might be providing?

Ms Stuart : We have discussions with our colleagues about those areas where the services work together, but it is not always funding alone that is the problem. Other concerns are whether people are trained and how they co-operate. I must put the record straight in relation to the hon. Gentleman's point about NHS Direct. His perception is that it takes 10 minutes to answer the call, 10 minutes to tell the story and 10 minutes to give the answers. He might have picked up on one incident where that happened, but the figures do not bear him out. The statistics show that NHS Direct in Hampshire answered 64 per cent. of calls within 15 seconds; it took 16,000 calls in March. There will be further improvements.

On Hampshire ambulance services, the national increase in demand has been reflected in Hampshire--

Mr. Hammond : Will the Minister give way?

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Ms Stuart : I should like to make progress, because a number of questions have been asked.

Mr. Hammond : They have not been answered.

Ms Stuart : May I have the chance to answer them?

Against the backdrop of increased call levels, ambulance service response times have improved significantly since we came to power. A year ago, only one ambulance trust--Staffordshire--was meeting the required target, but it is expected that most services, including Hampshire, will be achieving it by the autumn. By March 2001, 14 services had reached the target.

Mr. Hammond : Will the Minister give way?

Ms Stuart : Very briefly, and probably for the last time.

Mr. Hammond : I am very grateful. The Minister asserts that response times have improved since the Government came to power. Can she explain, then, why the percentage of eight-minute responses in Hampshire in 1997-98 was 51.8 per cent., falling to 44.5 per cent. in 1999-2000? Those are Department of Health figures.

Ms Stuart : Overall and in whole areas, performances have improved. As I said, a year ago only Staffordshire was meeting the 75 per cent. target; now, 14 of the 32 services are meeting it. I expect at least 29, including Hampshire, to have reached the target by the autumn. I know that progress in Hampshire has been slower than anticipated. That is simply not good enough. Hampshire ambulance trust and the local health authorities know that, too.

What is being done to increase the speed of progress? At my request, the Department's winter and emergency services team recently visited the trust and examined its improvement plans to ensure that all obstacles to progress had been identified. The trust's plan includes recruiting and training 58 more front-line staff, adding 11 emergency vehicles, strengthening control and support functions and changing staff rosters.

Hon. Members have spoken this morning of the need for additional resources for ambulance services. We recognise that, and the Government are committed to delivering first-class public services in Hampshire and throughout England. Because we are managing the economy better, we can afford record investment in public services. In 2000-01, we invested an extra

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£21 million in national health service ambulance services in England to help them to continue making progress by investing in extra vehicles and front-line staff. That funding has been made available on a recurrent basis and is being backed up with significant local investment. In Hampshire, that included £450,000 last year. A further £1.2 million is expected this financial year--an extra £1.7 million in total.

However, improving ambulance services is not just about more ambulances on the road; it is also about planning and partnership. The right hon. Member for North-West Hampshire (Sir G. Young) made a point about where vehicles are located. The hon. Member for Isle of Wight (Dr. Brand) referred to ambulances being told to wait in car parks, which are not proper conditions in which to work. In fact, we are talking about a sophisticated process of anticipating where accidents will happen. Ambulances do not always return to the same base. In some areas, for example, they may share facilities with the fire services. In my area, ambulances make what they would call pit stops, for cups of tea and so on, at their stations. All the services are working together, and the best way of using vehicles in the most appropriate places is kept under review. That is the partnership to which I referred.

With Hampshire ambulance service, we have seen co-operation and collaboration on many initiatives that have benefited patients and helped the ambulance service. Further investment has been made. We have invested £3.5 million in modernising the accident and emergency department at Southampton general hospital.

The hon. Member for Gosport (Mr. Viggers) referred to Haslar hospital. The reconfiguration process has not always been entirely happy, but the current arrangements mean that the services at the accident treatment centre will be continued. There is no particular timetable for Haslar's closure; we have said that it will coincide with the opening of the new private finance initiative hospital in Cosham. I hope that the hon. Gentleman is reassured that his constituents will continue to be served.

As for the review that many hon. Friends have mentioned, a formal period of statutory consultation will shortly commence. No decision has been taken; there is no fixed plan, as some hon. Members have suggested. We hope that implementation will be possible by 2002.

Our driving motivation is a better ambulance service, which serves the populations of all areas in the interests of patients, and responds to the changing needs of patients and to the reconfiguration of the NHS.

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