Sir George's speech follows, together with the response made by the Minister at the end of the debate.
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:
"Ten years ago we would have attended fire calls, road traffic accidents etc and we knew the ambulance would be only minutes behind us.
Now, we're having to get more and more of our staff trained in emergency first aid".
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. Member for Romsey, 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, 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:
"Equipment will either be refurbished or new. Owing to budget control it is not possible to order all new equipment immediately ... If you have not heard from us regarding provision of this equipment after four months please contact this office, when it may be possible to give the anticipated time before the items can be provided." My constituents are confused. The reassurances that they hear from Ministers do not match what happens in their everyday lives.
The hon. Member for Romsey 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 National Funding Formula for Health Authorities is at the heart of the problem. This is a challenge for central Government ... North and Mid Hampshire Health Authority receives 80 per cent. of the national needs assessment. Panel members felt strongly that this was too low." The next remark is especially interesting.
"We heard no evidence to support such a large reduction in the national needs "norm". What is more, we were told of both urban and rural 'pockets of deprivation' within the Authority, where an 80 per cent. allocation was arguably inadequate ... This challenge lies at the door of Government but the authority should fight for it, too."
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 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:
"Unfortunately, in common with many ambulance services across the country, we were unable to secure adequate additional funding to meet our identified needs."
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 have an opportunity in the not too distant future 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 when the Minister replies 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:
"Needless to say, these headline figures only give the tip of the iceberg." He added that the general increase, estimated at 4.9 per cent., was intended to meet the pressures on pay, prices and the cost of implementing the National Institute for Clinical Excellence recommendations. Significant cost pressures will need to be addressed, including a 2 per cent. rise in pension costs, the costs of implementing changes to junior doctor hours. The underlying financial deficit of the local health economy must also be dealt with.
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:
"There are many significant calls on this funding, particularly locally where there is an underlying financial deficit. Careful planning, phasing and prioritisation will be needed to deliver affordable and modern health services for local people." Against a background of some £30 million of savings, some of which will affect patient care, I asked whether, because more money was coming into the system, those savings could be abandoned. The response was that they could not because when plans for the savings were drafted it had been assumed that the extra money announced in November would be forthcoming. I quote the director of finance again:
"as the funding announced for next year is in line with the assumptions underpinning 'Meeting the Challenges', the proposals"-- the proposals to reduce services--"remain valid."
Will the Minister make it 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?
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 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 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 is 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.
To return to Hampshire ambulance services, the national increase in demand has been reflected in Hampshire--
Mr. Hammond : Will the Minister give way?
Ms Stuart : I should like to make progress, because a number of questions have been asked.
Mr. Hammond : You have not answered them.
Ms Stuart : May I have the chance to do so?
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 £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.
Let me return briefly to the specific points that were raised. 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.