East Midlands Ambulance Service
(11 years, 9 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
John Mann (Bassetlaw) (Lab)
I rise to highlight the problems of the reorganisation and funding of the East Midlands ambulance service. The problem has been covered up because, over the last 18 months, the service has lost the contract for non-emergency transfers of patients to Arriva trains and buses. Regardless of the question of service, the impact on the East Midlands ambulance service is £5 million a year. That was told to me, in advance of the loss of the contract, by the senior officials who ran the service. That £5 million a year has not been put back in additionally by the Government. Therefore, £5 million of cuts are required in the service.
To make those cuts, the service is attempting to reconfigure, which has a detrimental impact on my constituency and elsewhere, as I shall outline. Before doing so, I wish to highlight another problem for the Minister to respond to: targets and how they are set. There is currently an in-built pressure for ambulance services to meet specific targets. The reconfiguration is happening in the context of meeting those targets, but there are perverse incentives within many of them.
I shall highlight that with one example, but there could be many. A mother sadly lost her child last year. The mother went into premature labour at 29 weeks and the child, Jessica Day, died at birth. When the mother went into premature labour, she had a midwife with her and an ambulance was called, but none was available. A response vehicle with a single paramedic came, but Jessica Day’s mother needed—medically—an immediate transfer to an intensive care unit within a hospital to give the baby, Jessica, a chance of survival. Had that immediate transfer happened, on the balance of probabilities, Jessica would be alive. It did not happen because no ambulance was available. In fact, the nearest ambulance was on its way back from Sheffield on the M1 in Yorkshire.
That in itself is a major issue, but perhaps equally major is the fact that the target was met. Despite the fact that the mother with the baby needed to be in hospital immediately but did not get there for an hour and two minutes, the target was met, because a car arrived with a paramedic within 19 minutes. The mother and baby needed to be in an ambulance, and it was the right medical decision not to transfer them in their own car, which was available, as that would have endangered the mother as well. That is a graphic illustration of the problem.
As we see repeatedly, not least in respect of elderly people, if the target is not met, the ambulance does not come for many hours. For example, one 80-year-old pensioner was laying in a garden for more than an hour with a broken hip. Because the immediate response target could not be met, the emergency was de-prioritised, and the ambulance was sent somewhere else to meet another target—the second incident may or may not be as urgent. The longest wait I know of for an emergency response is 10 hours, but it is often three or four hours—with “often” not meaning daily, but certainly weekly. That needs to be looked at.
I also see a problem emerging with improvements. How could improvements be a problem? Over the last 11 years as an MP, I have called for a vast increase in the number of community defibrillators. I would like to see them in every community building, every significant employer, most small employers, every school and every parish council, with trained responders to use them. That would be wonderful, and a wise expenditure. All those defibrillators would be maintained by the East Midlands ambulance service, and every time one was used, it would be deemed to be an eight-minute response. Therefore there is a perverse incentive not to have community defibrillators in areas such as mine, because it would mean fewer ambulances. The community first-responder with the defibrillator would meet the response time, but the ambulance would not come in that minority of cases in which the patient needed to get to hospital. That is no good for my constituents.
It is similar for strokes. I would like to see localised thrombolysing done immediately in the way it is done in Iceland, for example. The brain image is scanned and sent to the consultant, wherever they are. They analyse it instantly and the decision on thrombolysing is made. That is done without having to take people to hospital, but we are light-years away from that simple system. The reconfiguration of the ambulance service now under way will worsen that situation.
There are bigger problems for people who do not live in a city. I want to go through some mathematics with the House to show the problems. The problem of averaging to meet targets means that, by definition, high-density cities will always be prioritised over low-density rural areas. I have a theoretical example, but it could be real in the east midlands. Suppose we have a city of 900,000 people and a rural constituency of 100,000 people. The average time for an ambulance to get to a job is much shorter in the city because of the density of population. In other words, the propensity of any square kilometre to have an incident is much higher simply because of the density of population. Therefore there will be a much higher level of vehicle cover in the city. But a 95% response time in the city and a 60% response time in the rural area—with the population figures I have given—results in a 91.5% response time overall. If those figures are reversed, with a 60% response time in the city and a 95% response time in the rural area—the exact opposite—the overall response time falls from 91.5% to 63.5%. Therefore, by definition, setting response times as they are means that ambulance services will disproportionately put their resources in the high-density cities rather than in rural areas. That is bound to happen, and the problem when the service faces a shortage of money is that when it reconfigures to meet response times, it has to downgrade the rural areas. It is not possible to do otherwise if response times alone are taken into account. The Minister needs to look at how the response times are set.
These are major issues for the Government, and I do not make those points in a hostile, partisan way. These are issues that successive Governments have looked at, but no solution has been found. Those things have to be changed. As well as Bassetlaw hospital, we use Doncaster royal infirmary—we are part of the same trust. We use Sheffield hospitals for heart attacks and cancer. However, the East Midlands ambulance service plans have been reconfigured to take us to King’s Mill in Ashfield, which is an entirely different area.
Gloria De Piero (Ashfield) (Lab)
The loss of ambulance stations in semi-rural areas is a particular concern. The town of Eastwood in my constituency faces the loss of its ambulance station. Does my hon. Friend agree that closing an ambulance station cannot help already poor response times?
John Mann
The figures I have presented to the House show this in-built bias against rural and semi-rural areas, and, not least, former mining communities. We have the proposals to close Worksop and Retford ambulance stations and to have one hub in Ashfield’s King’s Mill hospital to serve my population. The population of Bassetlaw will have a parking lot with a potential portakabin under the original proposals.
Toby Perkins (Chesterfield) (Lab)
Was my hon. Friend as surprised as I was to hear that the initial consultation has been replaced by a subsequent one which is suggesting doubling the number of hubs? I welcome the fact that there was some element of listening, but it suggests that the original plans were miles away from what was safe for the people in the east midlands.
John Mann
As you might imagine Mr Deputy Speaker, in Bassetlaw we had the biggest response to the consultation, with more than 19,000 people involved directly in the consultation, and we had the largest public meetings. We found one person—I will not name his political party, but he was the campaign organiser for a small party—in favour. All the other 19,000 who signed up were against it—every single person in the public meetings was against it. All the staff were against it—every single one of them. They were all against it because, if the ambulances and the base are shifted out of the area and we have just a parking lot with a portakabin, we will have an even worse second-rate, service in Bassetlaw. The averages will be maintained as the cities get our ambulances and we will not have them, and we will become the bit of the response time that is not met. My constituents will continue to die unnecessarily.
What I want from the East Midlands ambulance service, therefore, is a proper rethink. It is clearly rethinking, but I want to ensure that Worksop and Retford ambulance stations stay open. If they want to juggle the minutiae of where the management is based, I am not worried about that and neither are my constituents, but we want two proper bases. We want the Gainsborough ambulance service maintained to keep accessibility in the north-east part, the rural part, over the border in Lincolnshire. That is what we need if we are to maintain the kind of service that my constituents expect. They pay their taxes. We have our illnesses like everybody else. What is unacceptable to all of my constituents and to me is that former mining areas and rural areas have a worse ambulance provision than the rest of the country. We are not prepared to accept that. East Midlands ambulance service must come back with a proper proposal. In that proposal, Worksop and Retford ambulance stations will need to stay open so that there is a proper base to allow the staff to continue to do their excellent job. I thank the people of Bassetlaw for the way they have responded. They will continue to do so to ensure that we get the service that they deserve.
The Parliamentary Under-Secretary of State for Health (Anna Soubry)
I congratulate the hon. Member for Bassetlaw (John Mann) on securing this debate. Were it not for the fact that I now sit on the Front Bench, I would have put in for a similar debate—there is no doubt about it—such is my concern, as the constituency MP representing Broxtowe, about the situation with East Midlands ambulance service. It is important that I recognise that interest, because I, too, have had many concerns about EMAS, although they are perhaps slightly different from those the hon. Gentleman has described. As a result, I had a meeting with the chief executive of EMAS, Mr Philip Milligan, a week last Friday. I believe that he has since met the hon. Gentleman, so he will have heard about many of the issues that the hon. Gentleman raised in the House today, and rightly so.
I do not believe that this is simply a matter of finance—that is certainly not where my concern lies—or about the “Being the Best” scheme, which has been out for consultation, as the hon. Gentleman described. My concern, and that of many other hon. Members whose constituencies are covered by EMAS, is about poor response times, notably for elderly people who have fallen. My hon. Friend the Member for Loughborough (Nicky Morgan), for example, has had difficulties in her constituency, and I have had half a dozen problems in mine, with frail elderly people with suspected fractures having to lie on the floor, sometimes for up to four hours, despite being less than 10 minutes from the Queen’s medical centre in Nottingham. My hon. Friend the Member for South Derbyshire (Heather Wheeler) is nodding in agreement, as no doubt she has heard of similar experiences in her constituency. That situation is unacceptable, and I hope to offer some insight as to why that is the case.
Heather Wheeler (South Derbyshire) (Con)
In South Derbyshire we have had numerous cases of elderly people falling over in a park and having to wait hours for an ambulance. Residents have come to put blankets on them because they know that they should not be moved. We are 15 minutes from Burton hospital, but we cannot do anything because we rely on the professionals.
Anna Soubry
I am grateful to my hon. Friend for her intervention, but I think that it is also important to pay tribute to the ambulance staff who work for EMAS and the outstanding work they do. It is also important to point out that between October 2010 and December 2012 EMAS recruited 65 new front-line staff, so something is going on that is not right. Many people are of the view that unfortunately it is the way that EMAS is being run that is at the heart of the problem.
Mr Mark Spencer (Sherwood) (Con)
I wonder whether my hon. Friend is aware that Nottinghamshire fire and rescue service, if it has to be the first responder, is often left to look after patients until an ambulance arrives, which could be up to an hour, so the fire engine is not available to deal with a much more important issue.
Anna Soubry
As ever, my hon. Friend makes an important point, and it is one that I will certainly look at further. I hope that those in EMAS who are listening to the debate will take that comment on board.
In response to the points made by the hon. Members for Ashfield (Gloria De Piero) and for Chesterfield (Toby Perkins), I do not think that it is as simple as saying that the closure of an ambulance station will de facto reduce the service available. Ambulances do not sit in ambulance stations waiting to respond to a local incident. They spend most of their time out of ambulance stations on the road so that they can respond to emergency calls. EMAS reported—these are important facts that should be widely publicised; I am sure the hon. Member for Bassetlaw will ensure that they are—a total turnover of £169.5 million in its 2011-12 final accounts and a £1.4 million surplus. It has also reported surpluses in the previous three years. I understand that for 2012-13 the trust received £3.5 million funding as its share of the EMAS contract from Bassetlaw primary care trust. As I have said, my concern is not so much about the money, but about the way the service is being operated.
Let me turn to the “Being the Best” review. EMAS tells me that it recognises that its response times in rural areas do not match the response times in city centres. In response, EMAS published its “Being the Best” change programme in 2012, which outlined plans designed to ensure that response times and the service provided to all the people of the region were improved. As the hon. Member for Bassetlaw described, EMAS has consulted clinical commissioning groups, overview and scrutiny committees and local people on its proposals. As we have been told, it received substantial feedback from the people of Bassetlaw, with a petition from some 9,000 people. The business case should be presented to the board on 25 March, allowing the trust additional time to review alternative options and develop final proposals for the board to consider.
I am told that a number of options are being considered. They include the “do nothing” option, which involves making no changes to the configuration of ambulance stations; the “do nothing-plus” option, which involves making no changes to the configuration of ambulance stations, but making an additional resource investment in more ambulance vehicles and staff; and the “do minimal” option, which involves making the minimum changes necessary to deliver current service standards in a safer and more effective manner. That option would retain all the current stations and introduce the 118 new community ambulance posts. The fourth option would establish 13 hubs, plus 118 community ambulance posts—I know that my hon. Friend the Member for High Peak (Andrew Bingham), along with many hon. Members, has expressed his concern about that option. The fifth option—a new option—would establish 27 hubs, plus 108 community ambulance posts, and is being considered as a direct result of the consultation feedback.
Andrew Bingham (High Peak) (Con)
Does my hon. Friend think, like me, that although the hub and spoke model has merit, the key is where the hubs go? High Peak is very rural; we need a hub, as I am sure the hon. Member for Bassetlaw (John Mann) feels he does.
Anna Soubry
That is a very good point. My hon. Friend has summed it up—we are having an outbreak of cross-party unity. As he says, the key point is the positioning of the hub. One of the attractions of the hub approach is that the mechanics would be in place to ensure that the vehicles were ready at the beginning of a shift. At the moment, paramedics are responsible for that, which does not seem to be a very good use of their time. There is therefore much merit in establishing 27 hubs in the right areas to ensure that we have a service that is fit for purpose.
There is something else that needs to be, not so much explored, perhaps, as exposed. The hon. Member for Bassetlaw has quite properly commented on the difficulty of having targets, and I could not agree with him more. This debate is a good example of where top-down, Government-led targets have blighted an ambulance service—no doubt there are many other examples in the NHS. That is why, when this Government were elected, for many of us it was on the basis that these targets, far from freeing up services and making them better, were strangling them and making them worse. This debate is an example of targets doing all the things they were designed not to do, constricting a service and making it worse. It is worth bearing it in mind that it was in 1997, I believe, that the ambulance service suffered from such targets. I hope that there will be more cross-party agreement and moving forward, so that although there are laudable aims that all services should have, we should not necessarily set rigid targets, which then create exactly the sort of horribly sad cases that the hon. Gentleman told us about.
Anna Soubry
No, the Minister is not saying that she is going to get rid of them; what I am saying is that I take the view—as the hon. Gentleman does—that targets are not particularly improving services. I think there is a case for re-examining targets, and I hope he would join me in saying to the ambulance service, “Let’s look again at these targets in the NHS to see whether they’re doing the job we want them to do,” because it is precisely because of these targets that elderly people in my constituency have been lying on floors for up to four hours while ambulances have to go to meet a target.
Toby Perkins
The hon. Lady seems to be saying that the ambulance service is so focused on targets that it is incapable of recognising that leaving an old lady lying on the floor for four hours is reprehensible and appalling. She is letting the ambulance service off tremendously lightly to suggest that that is reasonable.
Anna Soubry
I am not saying that it is reasonable at all. What I am saying is that this was the system introduced under the last Labour Administration— a Government whom the hon. Gentleman supported. These are the precise consequences of that system; it is the perversion of that system that has led us to a situation in which targets have to be hit. I can assure hon. Members that I explored this matter with Mr Milligan, and an elderly lady lying on the floor with a suspected fractured hip does not fall into the category of an emergency life-threatening situation. These are not definitions imposed by this Government; these are the consequences of the 13 years of the previous Administration. I take the view that the situation needs urgent review, and I will certainly be making that recommendation in the Department that we need to look again at the ambulance service.
Mr Dennis Skinner (Bolsover) (Lab)
Does the Minister agree that a lot of people in the east midlands, including many of the Members who have spoken here tonight, are dealing with pretty much the same kinds of characteristics in the old mining areas and rural areas? In my area of Bolsover and mid-Derbyshire, it seemed as though the 17 control centres were going to be reduced to two. I get the impression that the Minister is saying that most of the 27 would be likely to remain. It is hard for me to say this, but do we have a cross-party agreement to save those in mid-Derbyshire that cover Bolsover as well?
Anna Soubry
I have to say that, for the first time, I am almost speechless. It is not for me to say what is my preferred option. That decision has to be made at a local level. As the hon. Gentleman might imagine, however, I may have a point of view on the preferred option, and I am entitled to make my view known to EMAS, as indeed I will. I take the hon. Gentleman’s important point about the former coal-mining communities —they are similar to my own, although mine is not on the same scale as Bolsover. I make the point again, however, to be fair to EMAS, that the reason it has gone through this process—which has been painful for many people—is precisely because it wants to improve its service. It recognises that rural areas do not receive the kind of service that urban areas do.
Chris Heaton-Harris (Daventry) (Con)
In the last couple of minutes, will the Minister address the concept of regionalisation of a service such as this? We have previously seen money being wasted on the regionalisation of the fire service, and many of us with constituencies on the periphery of the East Midlands ambulance service really worry about this. The hon. Member for Bassetlaw (John Mann) talked about the hospitals outside the region that his constituents go to. My constituents go to hospitals in Oxford, Coventry and elsewhere. Does this mean that those of us in the rural outreaches of the east midlands are the ones who have to pay for this centralisation?
Anna Soubry
My hon. Friend’s intervention raises a point that I hope I can help him with. There is absolutely nothing to prevent an ambulance in Daventry from going to whichever hospital offers the best treatment for that particular patient. Exactly the same applies in Bassetlaw. Under the new rule, there will be nothing to prevent a patient from going to Doncaster royal infirmary, or up to Sheffield, or indeed down to the Queen’s medical centre in Nottingham. The changes will not affect the ultimate decision of which is the best hospital for that particular patient—[Interruption.] The hon. Member for Bassetlaw is chuntering at me. Does he wish to intervene on me?
Anna Soubry
With great respect to the hon. Gentleman, he misses the more important and indeed more valid point that just because there is an ambulance station in a particular town or village, that does not mean to say that there is always an ambulance sitting there waiting to serve that town or village. What is important is—