Andrew Bingham (High Peak) (Con)

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I want to raise the issue of ambulance stations in my High Peak constituency. First, for the sake of clarity, I should explain that the High Peak is a large constituency and as such is covered by two primary care trusts: Derbyshire in the south and Glossop and Tameside in the north. Consequently, the ambulance services are provided by the North West Ambulance Service NHS Trust and the East Midland Ambulance Service NHS Trust. I want to concentrate today on the East Midland Ambulance Service—EMAS—but if time allows, I will also briefly mention the North West Ambulance Service.

“Being the Best” is an EMAS proposal to rationalise the ambulance services and ambulance stations across the whole of the east midlands. I am sure many Members across the east midlands will have their own issues in their own constituencies. I want to highlight the consequences for the residents of a large part of the High Peak of what I believe are badly thought out and ill advised proposals.

EMAS is looking to create a hub-based model. A hub will be, as the word suggests, a large centre where ambulances will be based and where crews will go to collect their vehicles and return them at the end of the shift. The hubs will be supported by what EMAS calls “deployment units”. I have seen a photograph of a deployment unit and I venture to say that, if we in this Chamber saw one, many of us would say it looks remarkably like a portakabin. They look unattractive, which does not go down well in an attractive area such as the High Peak where the scenery is so well appreciated, and also seem to be of very little use. I can see the logic of a hub-and-spoke model, but the crucial decision within such a model is where the hubs are located. That is where I believe EMAS has got things so badly wrong for the High Peak.

There are presently two ambulance stations in the EMAS area of the High Peak: one in Buxton and one in New Mills. Under the EMAS proposals, both of them will be removed, leaving the area without an ambulance station at all, relying instead on a hub that is placed not in or even around the High Peak, but in Chesterfield—at a distance of over 30 miles from New Mills, which is the furthest point. EMAS claims that the ambulances will not be parked there, but merely collected from and returned to the hub. That may be the case, but it creates further difficulties, as I shall explain.

The High Peak gets its name for a very good reason—it is high and there are peaks. The road from Chesterfield into the High Peak reaches at some points almost 1,000 feet above sea level. It is exposed to the elements. Many areas around different parts of the north and the east midlands might see only a sprinkling of snow, but Tideswell Moor, as part of the road is called, can easily be closed: owing to its exposure, only a small amount of snow is required to drift across the road to make it impassable for many vehicles. I use that road every week to catch the train to London. I well remember one occasion when I returned from London, got off the train in Chesterfield and quickly realised that I could go no further. I had to stay overnight in a Chesterfield hotel. I had that option, but somebody in the High Peak who needs an ambulance to use that road does not.

Let us imagine a crew collecting the ambulance to go on shift. They leave the hub, and within a short time a 999 call is received, requiring them to divert to, for the sake of argument, Clay Cross. The ambulance goes to the call, collects the patient and takes them to Chesterfield hospital—a process that could take some time. I have been out with the ambulance crews and I know how long these things can take. From Chesterfield hospital, the crew could get further diverted to, say, Alfreton or Matlock. That could mean the ambulance never reaching the High Peak, leaving my constituency with no ambulance cover at all.

I realise that my case requires a working knowledge of the geography of north Derbyshire, but that further makes my point, as it is precisely that knowledge that was lacking or ignored when the plans were drawn up. In meetings with me, EMAS says that the model has been computer generated. I have to say that it may look good on paper, but it does not and will not work in reality. EMAS also says that “Being the Best” is about improving the service and improving staff welfare. I fail to see how it can even begin to satisfy either of those criteria. How can staff welfare be increased when many of them will face an extra 30-mile journey to work both before and after what could easily be a 12-hour shift?

In addition, EMAS will be committed to compensating staff for excess travel for a certain period following the move. Extra fuel costs will be incurred by the to-ing and fro-ing from the Chesterfield hub—not to mention the cost to the environment with all the extra miles that the staff will have to travel. That means reducing staff welfare while increasing costs and reducing efficiency—to my mind, the direct opposite of what EMAS is trying to achieve.

The knock-on effect will be that, through staff turnover, the High Peak will lose ambulance men and women with the crucial local road knowledge. High Peak residents wishing to become paramedics or to work on the ambulances will now apply to the North West Ambulance Service, whose operational centres are nearer. We will arrive at a situation whereby whatever ambulances we get in the High Peak will be staffed not by local people who know the local towns, villages and hamlets in the area, but by able and excellent staff—I concede that—who will be residents from miles away. They will not be able to find their way around—sat-navs do not work that well in the High Peak—and response times will increase even further.

The fundamental problem is the way the process has been undertaken and how the proposals have been arrived at. The North West Ambulance Service is looking at similar proposals, but it appears to be engaging with others, inviting key stakeholders to help to discuss and shape its plans. At a meeting, it referred to the hub-and-spoke model but, I am told, acknowledged that that method of delivery will not suit all areas. I do not wish to prejudge what NWAS may propose, but there appears to be an acknowledgement that one size does not fit all. EMAS, however, presented its proposals with little or no apparent discussion with anyone, key stakeholder or not, preferring to use what appears to be an off-the-shelf template.

As Members would expect, I am batting for my constituents. We deserve a better ambulance service. We have several large quarries and other industrial premises within the High Peak, and they can be dangerous places. Industrial accidents happen. Safety records in the High Peak are good, but there is still the risk of injury.

Let me also dwell a moment on what happens in the summer months. The High Peak can be flooded with tourists. The population swells, and with it the potential risk and the need for an ambulance rise. Walkers, hikers and runners swarm across the High Peak hills like ants. Theatre-goers fill Buxton and the surrounding towns and villages during the Buxton festival. Coach-loads of people come to my constituency during the summer months. Who will go to them if they need emergency assistance?

The first responders, who perform excellent work in the High Peak, have expressed opposition to these plans. I am a great supporter of Mountain Rescue. It does a fantastic job across the High Peak, and in some cases its specific services are needed to reach people in inaccessible areas. Even it has taken the unusual step of expressing grave concerns about these proposals. Derbyshire, Leicester and Rutland Air Ambulance is also a vital part of the emergency mix in the High Peak, but the main ambulance service is still the one that people call most often. These other organisations embrace their responsibilities, but I am concerned that these proposals are leading to EMAS abdicating theirs.

The consultation has now closed. The whole High Peak community has united as one against these proposals. Two public meetings were attended by hundreds of local residents incensed by the proposals. At one meeting I attended, the chief executive said he was “listening very carefully” to local people. I hope he is. I hope that, when he presents his final recommendations to his board, they are not the same ones that are on the table today, as they are inadequate, unfeasible and unworkable: they reduce, not enhance, the service; they hamper, not improve, staff welfare; and they desert, not embrace, the people of the High Peak in their hour of need. The current proposals may improve some response times elsewhere, in the more populated areas of the east midlands, but they will not improve response times in the High Peak.

John McDonnell (Hayes and Harlington) (Lab)

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And privatising.

Dr Thérèse Coffey (Suffolk Coastal) (Con)

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It is a great pleasure to speak in this debate on a particularly important topic, in which the Minister shares an interest, as we are neighbours. First, I wish to thank our front-line staff in the ambulance service, our paramedics, who work very hard. I also thank our volunteers, the community first responders, who do a great job and genuinely participate in helping to save lives in our communities. That is particularly important in the shires, as reaching someone in just a few minutes to provide life-saving treatment is crucial. I thank those people who give up their time.

A reorganisation is taking place in the east of England ambulance service, and I know that that is a concern to staff, who feel that patients will not get the treatment that they deserve. Change is always unsettling, but I genuinely believe that the management are trying to do this for the best reasons. One of the things we need to keep ensuring is that patient safety is the key priority.

The east of England ambulance service is hitting its targets—it has a regional target. Given that our region is so vast, it is no surprise that by focusing on certain cities it is relatively straightforward to hit targets. However, when we break down the performance by county, we start to see a very different story. I know that my colleagues from Suffolk and, indeed, my hon. Friend the Member for North Norfolk (Norman Lamb) have long been campaigning on that issue to try to raise it up the agenda, and it is vital that we do so. The presence of a new interim chief executive may start to help us to tackle that. We need to work hard to keep the chair and the board of the ambulance service on their toes, so that they recognise that saying that they have hit a regional target does not mean that the issue will go away—it will not.

One of the things I call on the board to do is think carefully about its responses to Members of Parliament when we are asking for greater transparency on performance. Belatedly—I am pleased that it has done this—there is an agreement that it will start to publish county by county performance details on a monthly basis. I believe that the board should and can go further. We already know that it provides performance data by postcode to the primary care trusts, and I believe those data should be published—they should certainly be available. Instead of getting into freedom of information exchanges, we need to ensure that, in line with what Sir David Nicholson told the Public Accounts Committee, every Member of Parliament should be able to get access to the data they need easily in order to monitor what is happening for their constituents and not be caught in a bureaucratic nightmare. As we all know, sunlight often brings a change in performance. Somebody trying to get to a village such as Shingle Street finds that it takes 10 minutes to get there just from the main road. When I say “main road” I am referring to a single track road. I recognise that not everybody will be able to do that, but it is still important that we try to get the postcode data published.

Earlier this year, after a successful meeting with my right hon. Friend the Member for Chelmsford (Mr Burns), a Health Minister at the time, I was under the impression that there would be a contract with the county performance targets built into it. Indeed, that was important for the paying of bonuses. Disappointingly, the contract that was agreed with the ambulance service by the person agreeing it on behalf of the primary care trusts in the east of England contained an added caveat about hospital handover times. We know that that is an issue, but another thing that Members of Parliament are doing is putting the spotlight on where there are those problems as well. Ultimately, we want the best ambulance service for our patients. We should not have to put up with sub-standard performance simply because the county is rural.

One disappointing thing about the contract, from which we expected so much, was that there seemed to be a lot of wriggle room. The new interim chief executive knows that well, as he negotiated the contract on behalf of the primary care trusts. He knows the issues our ambulance services face and I shall press him to ensure that the contracts this time make it clear what percentage of people in Suffolk should expect to see an ambulance within the regulated time.

Another thing that went wrong was the complaints process, although I am delighted that the chair of the ambulance trust has fixed that. I pay tribute to her and her staff for sorting that out. All these problems together have led me to voice my opposition—I will continue to do so—to the trust’s being allowed to have foundation status before a quality service is delivered consistently across the region. Simply placing ambulances close to Cambridge, Ipswich, Norwich, Luton and so on—near the big conurbations—is not fair on our rural areas. I point those people who say, “Well, it is a rural area,” to the example of the north-west. Cumbria has very similar characteristics as a pretty rural area with some big towns, yet the service there manages consistently to hit its targets.

Is there light at the end of the tunnel? I hope so. It is clear that MPs from Suffolk and across the east of England will not let up on the issue and I hope that we will have a step change in performance when we meet again in February.

Health care is very important to the people of Suffolk, but I also want to take this opportunity to thank my staff for all the hard work they have done in the last year. They have been extraordinary in helping my constituents tackle all sorts of issues and have also been very helpful this week, as we have sent out a mailshot of nearly 4,000 letters on Sizewell C—another issue that I share with my hon. Friend the Minister—and the impact that could have in the future. On that note, Mr Deputy Speaker, I wish you a happy Christmas.

Jeremy Lefroy (Stafford) (Con)

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In September 2012 the Royal College of Physicians published a report, “Hospitals on the edge? The time for action”, which sets out starkly the challenges facing our acute hospitals. It begins:

“All hospital inpatients deserve to receive safe, high-quality, sustainable care centred around their needs and delivered in an appropriate setting by respectful, compassionate, expert health professionals. Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population and increasing hospital admissions.”

It highlights the consequences of failing to meet the challenges and refers to the history of my own trust. When the public inquiry reports next month, we will have the opportunity to consider its implications for the NHS. Today I wish to concentrate on the Monitor review of my trust in the light of the continuing rise in pressure on acute services that the Royal College of Physicians highlights.

There are three common themes that I hear in the NHS these days. The first is that we need to do much more in the community and at home and much less in acute hospitals, and that we must therefore close acute hospital beds and use the money in the community. Although I agree with the premise, I dispute the conclusion. Community care is essential, but it must work before it results in a reduction in admissions and lengths of stay. The fact that admissions are rising and, according to the RCP, the fall in length of stay has flatlined in the past three years, even rising for patients over 85, indicates to me that the shift to the community either is not happening fast enough or indeed will not happen as expected.

The conclusion also seems to ignore demography. In the area served by the Mid Staffordshire Trust, the population is expected to rise by some 10% in the coming 23 years. The number of people over 60 will rise by nearly half, and the number of those 75 and older—those most likely to need acute services—will double. I suspect that is the situation in many parts of the country.

Increasing admissions, rising and ageing population, flatlining length of stays—all of these indicate an increased demand for acute services in the coming 20 years, yet the talk is, and has been for many years, of further reductions in acute beds. It makes little sense to do that until community services and other medical advances mean that those beds are proved to be no longer necessary. In Stafford, there is a shortage of step-down beds, so rather than closing acute beds altogether why not keep them as community beds on the same site, leaving the door open for increasing acute services in the future, if and when the need arises?

The second theme is that we need to integrate primary and secondary care more closely. I agree, yet actions sometimes have the opposite effect. The previous Government took away the responsibility for providing 24/7 primary care cover from GPs. I regret that, as it detracts from integration. It may also be responsible for placing a greater burden on accident and emergency departments at night. If out-of-hours care is not to be the responsibility of GPs, let it be centred, where geographically possible, on acute and community hospitals. This makes better use of NHS premises and, by being adjacent to A and E or other emergency units, can help take the pressure off them while providing the hospital with extra income. That would certainly work at Stafford and Cannock.

Tariffs can produce strange results. The University Hospital of North Staffordshire has a block contract for A and E admissions. For any admission in excess of that, it receives only 30% of the tariff, so what is it supposed to do—reject emergency admissions on the basis that they will be loss-making? Of course not. I would propose that emergency departments are funded at what it costs to provide that service safely. In Stafford, the emergency department has a deficit of some £2 million per year based on throughput and tariff. The number of patients attending—more than 50,000—could not possibly be safely accommodated elsewhere. Surrounding hospitals are already at capacity, so it makes little sense to impose a national tariff, which inevitably results in a loss and which in turn puts pressure on the hospital to prove that it is sustainable.

The third theme is that medicine is becoming increasingly specialised, so most work will inevitably migrate to large specialist units. There is truth in this belief, but there is also danger. There are 61 approved medical specialties in the UK, compared with 30 in Norway. As the RCP says, this has

“rendered the provision of continuity of care increasingly difficult.”

For older people, who often have complex and multiple needs, this can result in poorly co-ordinated care. This has not been helped by the introduction of shift-based systems under the new deal and the European working time directive, to replace the teams that took responsibility for individual patients. Specialisation also means that there is a much smaller pool of staff from which to select for each post.

If we were to design from scratch a hospital where those who will need it most— the elderly, as the statistics show—will receive safe and caring care for their complex needs as close to home and loved ones as possible, integrated into primary and community care, we would end up with something pretty much like the district general hospitals and community hospitals up and down the country, such as Stafford and Cannock.

This is not an argument for no change. I believe there must be much closer working between the larger and smaller trusts, for instance, and much more sharing of common services than at present. But it is a warning that national tariffs are not impartial arbiters. They generally work, I believe, against acute care.

Jeremy Lefroy

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I thank the hon. Gentleman for his intervention. I am not convinced that that is the case at all. I believe Ministers are listening and are considering matters very carefully, but there is a danger, of course, that a template will be inflicted. The hon. Gentleman and I both earnestly trust that that will not be the case.

As I said, I believe that national tariffs are not impartial arbiters. They generally work against acute care, and there is a risk that the constant pressure which they are placing on acute care, particularly in district general hospitals, will make much of the sector unsustainable, yet without it, we do not have an NHS.

Finally, I wish to raise a specific point about Monitor’s review of Mid Staffordshire. Clearly, the population served by the trust is a very important consideration. The trust’s 2011-12 report said that it was around 276,000, yet I have heard reports that the Monitor team considers it to be as low as 220,000 and therefore potentially too small to sustain certain services. The facts that I have clearly support the trust’s figure, not the one that I have heard rumoured.

I have spoken much today about figures, because they are an important part of the Monitor review, but more important is the quality of services, for which Monitor also has a legal responsibility. Early next year, the Secretary of State will bring to the House the report of Robert Francis QC from his public inquiry into Mid Staffordshire. Julie Bailey and the Cure the NHS group, who from their own experiences brought to light the harm that was done, have set out radical and clear ideas for turning the NHS the right way up, with the patient at the top, not the bottom—right first time with zero harm to each and every patient. That is something which caring, hard-working staff in our NHS in Stafford and Cannock—where waiting times and mortality rates are improving, although there is much to be done—and right across the country went into the NHS to provide.

The NHS, as the right hon. Member for Wentworth and Dearne (John Healey) said, and the nursing and medical professions must make it clear that there is no place for anyone for whom quality patient care does not come above all else. The regulations must show that.

The Monitor review is an opportunity for Stafford and Cannock hospitals to become a model of how to provide sustainable high quality emergency, acute and community care to a mid-sized population. If Monitor succeeds in achieving this there and elsewhere, as the hon. Member for Lewisham West and Penge (Jim Dowd) mentioned, it will have done the nation a great service, and I am sure the Minister will be remembered as someone who played a major part in improving our NHS. I urge Monitor to rise to the challenge.

Dr Poulter

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My hon. Friend is absolutely right and I pay tribute to him for taking the time to go out with the ambulance service and see first hand the problems that have been experienced in some parts of Suffolk and Norfolk. There have been problems with the handover time at some hospitals in the east of England and that is clearly unacceptable, because if the ambulance and hospital staff are engaged in lengthy handovers, it means that other patients are not being treated and seen in a timely manner. Those issues need to be addressed by some trusts in the east of England.

My hon. Friend the Member for Waveney has written to the ambulance service and his letter was made available to my noble Friend Earl Howe. In it, he highlighted the trust’s decision to publish more performance information online from February and stated that it was important that that was done by geographical area to ensure that there is greater transparency in the quality of response data in areas such as Beccles and Bungay, relative to more urban areas such as Ipswich. That is an important point. I urge him and my hon. Friend the Member for Suffolk Coastal to continue pushing for transparency in the ambulance service’s data, and to continue their fight for improved response times for more rural areas of Suffolk and Norfolk. I know that my noble Friend Earl Howe would be happy to meet hon. Members to discuss the matter further.

Let me turn to the issues that were raised by the other three Members. I will be brief, Mr Deputy Speaker, because I take your hint. My hon. Friend the Member for High Peak (Andrew Bingham) raised concerns about a number of ambulance stations, including one in Buxton. I know that my hon. Friend the Member for Staffordshire Moorlands (Karen Bradley), who lives in a nearby constituency, shares those concerns. A review is currently taking place. We all welcome reviews if they are going to improve the quality of care for patients and improve ambulance response times. However, there are local concerns that the review must take into account issues such as rurality and the difficulties that patients on high land or in harder-to-access areas have in accessing all types of health care services.

I note the concerns that the review is making proposals that do not necessarily take account of those factors. My hon. Friend the Member for High Peak has put those concerns on the record today. If that has happened, I echo his concerns, because it is important, in the review of any service, that issues such as rurality and difficult-to-access areas are taken fully into account. This is, of course, a local health care decision. If he wants to discuss the matter further with Ministers, we are happy to discuss it with him.

The hon. Member for Lewisham West and Penge (Jim Dowd) put across his strong advocacy for Lewisham hospital. I trained in south Thames and have colleagues who work at Lewisham hospital. We all know that Lewisham faces particular challenges. It has demographic challenges, given its difficult population groups with considerable health care needs, and great health care inequalities. It has a large migrant population, which brings particular health care challenges and means that people do not always have English as a first language. Such people need to be looked after properly. It is important that those issues are taken into account during the discussions.

I take on board the concerns of local staff that they are being drawn into the big financial concerns with South London Healthcare NHS Trust. However, we also have to recognise that no one hospital operates in a vacuum. We must ensure that hospital services and the care that is provided reflect the needs of the wider geographical area. My right hon. Friend the Secretary of State will be looking into these issues.

Dr Poulter

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I will take an intervention very quickly, but I am pressing on Mr Deputy Speaker’s patience.

Mr Deputy Speaker (Mr Nigel Evans)

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Order. Please complete your contribution within 60 seconds, Minister, so that we can move on.