Scottish Ambulance Service (Rest Breaks)
The next item of business is a statement by Nicola Sturgeon on Scottish Ambulance Service rest breaks.
Before we turn to it, I put on record my disappointment that important matters relating to the statement appear to have made their way into this morning’s press. I have reviewed the coverage and I have sought and received assurances that the Scottish Government was not the source of the information. However, I stress that it is incumbent on the Government to do everything in its power to ensure that statements made to this Parliament are received in the Parliament first and not trailed in the media in advance.
The cabinet secretary will take questions at the end of her statement, therefore there should be no interruptions or interventions.
14:56
I am grateful for the opportunity to update Parliament on the progress that has been made towards resolving the rest break issue within the Scottish Ambulance Service.
I want first to provide some of the background to the issue. The background is important because it explains why the Ambulance Service is in this situation and what it has done to address the issue over a number of years.
As members will be well aware, 2004 saw the introduction of the national health service agenda for change, a new pay system for staff employed by the NHS across the United Kingdom. Agenda for change harmonised the terms and conditions of service in relation to annual leave, working hours, sick pay and work done in unsocial hours for all non-medical staff in the NHS across the UK.
Prior to agenda for change, Scottish Ambulance Service staff were employed on a 40-hour week inclusive of meal breaks. Following the introduction of agenda for change, the arrangements were harmonised with the rest of the NHS, resulting in a change to a 37.5-hour working week exclusive of meal breaks.
At the time of implementation, it was not possible to agree a common approach across the UK on how ambulance services should handle the rest break issue. In order to fulfil the desire to continue to provide adequate emergency cover, the Scottish Ambulance Service management and the trade unions reached an agreement in 2006 to introduce a voluntary arrangement.
The arrangement allows for front-line operational staff who volunteer to make themselves available to work during their unpaid break to be paid an annual allowance of £250. The allowance is paid on the basis that staff will continue to receive a rest break but will be prepared to be flexible about when it is taken and are willing to be disturbed in an emergency. In addition to the £250 annual payment, an activation payment of £5 is paid when a staff member is required to respond to a call during a rest break.
All staff are asked on an annual basis whether they wish to be available during rest breaks. Take-up of the voluntary scheme has remained fairly constant over the past five years at around 20 per cent of eligible staff. It is worth pointing out that the 540 staff who signed up in 2010-11 were disturbed in total 2,150 times during their rest breaks in that year. That is an average of fewer than four times per person over the course of a year.
Notwithstanding the voluntary scheme, the current arrangements can still lead to a situation in which a critically ill person is not attended to by a nearby ambulance crew. That is not an acceptable situation. Not only does it potentially compromise patient safety, but it is not in the interests of ambulance staff either. Staff in those circumstances are abiding by their contract of employment. As they are on a break, the command and control system used to deploy crews does not recognise them as an available resource. However, as a result of where they are when they take their rest break, the staff can subsequently find themselves the subject of public and media anger.
Two recent tragic cases in Tomintoul and Crieff have highlighted the degree of concern that the public and members of this Parliament have about the issue. The Scottish Ambulance Service management and trade unions therefore entered into extensive negotiations in an attempt to resolve the rest break issue in July this year. Negotiations concluded on 12 August, with an offer being put to staff in a ballot. The three trade unions involved recommended acceptance but, in spite of that recommendation, the offer was rejected by all three unions towards the end of September.
In the light of the ballot results, I met the unions on 29 September—last Thursday. I made it clear to the unions that I heard the message of the ballot results and reiterated my strong commitment to working with them in partnership to address concerns and, if at all possible, to find a longer-term solution that staff would feel able to support. Talks between management and trade unions will, therefore, continue.
However, while supporting those continuing talks, I and the Scottish Ambulance Service have a responsibility to ensure that patient safety is protected. In my judgment, simply leaving things as they are while those further talks take place is not consistent with fulfilling that patient safety responsibility. Therefore, I have decided, in agreement with the majority of the unions involved, that the terms of the offer will be implemented for an interim three-month period while talks continue. That interim arrangement will be in place from 6 am on Monday 10 October.
I will lay out the key elements of the interim arrangements, including who will be covered, what category of calls they will apply to and what the compensation for staff will be. I will also explain how the arrangements will be monitored.
It is fundamental that the Scottish Ambulance Service gives an absolute guarantee that rest breaks will be provided for staff. Any member of staff who is disturbed on a rest break will be able to take their rest break later in their shift. Nothing in the new arrangements will be allowed to compromise the health and wellbeing of our hard-working ambulance staff. Staff will be disturbed during a rest break only if it is to respond to a category A call or a major incident; in other words, the arrangements will be invoked only on rare occasions. The arrangements will apply to all accident and emergency operational vehicle crew staff, urgent tier staff, air wing staff and special operations response teams.
In return for requiring staff to be available during rest breaks, the Scottish Ambulance Service will pay an annual fee of £250 to all staff to whom the arrangements apply. Initially that will be paid on a pro rata basis for the next three months. In addition to the £250 annual payment, staff will receive an activation payment of £100 if they are disturbed during a rest break. That is a doubling of the £50 activation payment that was proposed in the offer that was put to staff last month. I stress that the purpose of the activation payment is twofold: it is designed to compensate staff for being disturbed during a rest break and to be a disincentive to the Scottish Ambulance Service to invoke the arrangements. I hope that it will give an assurance that the Ambulance Service will not disturb staff unless it is absolutely essential to do so.
As I have indicated, the arrangements will apply from 6 am on Monday 10 October and will remain in place for an interim three-month period, during which talks with the trade unions will continue.
The interim arrangements will be supported by a standard operating procedure, which will provide detailed guidance on when it is appropriate to interrupt a rest break. It will set out the dispatch protocols for control room staff and it will detail the monitoring arrangements that will be put in place to ensure that staff are not being inappropriately or unnecessarily disturbed. The monitoring arrangements are particularly important, as they will allow the Scottish Ambulance Service to demonstrate to staff—and demonstrate to me—over the next three months that the arrangements are being used appropriately. They will include the nomination of a union steward in each control room to monitor the application of the rest break policy. A report will be sent from each control room on a weekly basis to the Ambulance Service’s executive team, detailing the number of times that rest breaks have been disturbed and the reasons for that. Over the next three months, I will receive that weekly report and will discuss with the Ambulance Service and the unions any issues or concerns that arise from it.
These interim arrangements are in the interests of both patients and the staff who work so hard on our behalf in our ambulance service. However, the Scottish Government is committed to continuing to support the Ambulance Service in finding a longer-term, sustainable solution to the issue. I have, therefore, tasked my officials with working closely with management and unions over the next few months to consider any necessary redesign support to improve operational deployment and to ensure that, at the end of the interim period, we have a permanent solution to put in place.
The steps that I have outlined allow me to be assured and, more important, allow me to reassure the public that patient safety is paramount, that the views of the workforce are respected and that the Scottish Government and the Scottish Ambulance Service will continue to seek a way forward in partnership.
I am happy to answer any questions that members have.
The cabinet secretary will now take questions on the issues raised in her statement. I intend to allow about 20 minutes for questions, after which we will move on to the next item of business.
I welcome the cabinet secretary’s statement and thank her for an advance copy of it. We all agree that there should be no delay in responding to category A 999 calls, just as we all agree that ambulance staff deserve appropriate breaks. I note that negotiations are continuing and I hope that there will ultimately be a satisfactory outcome.
I have three questions for the cabinet secretary. First, can she assure me that the halving of the Scottish Ambulance Service overtime budget will not impact on response times? There are real concerns about that, given that the budget has been relied on to provide the existing service and we know that the number of calls is growing.
Secondly, the cabinet secretary will recall that, over a year ago, she took a trip to Belfast. It took that trip to expose the problems with the control rooms in the Scottish Ambulance Service. Despite assurances to the Parliament, there appear to have been a further five breakdowns in the control room telephony, leading to a possible fatality due to the delay. Can she give an update—if not today, perhaps in the future—on the arrangements to ensure that the control rooms are working effectively?
Thirdly, members of the public, like me, will perhaps be surprised to learn that the Scottish Ambulance Service is not classed as an emergency service. That might make a difference to how rest breaks are considered. As part of the negotiations, will the cabinet secretary consider making appropriate parts of the Ambulance Service an emergency service?
I will deal with the final question first. In my view, the Ambulance Service is an emergency service. I hear the distinction between emergency services and essential services. I do not think that that is borne out in some of the working time directive regulations, for example. If there is anything that we require to do in the negotiations to put that beyond doubt, I will certainly be happy to do it, because in my mind the Ambulance Service is an emergency service. That is how the public see it, it is how we should see it, and it is how the Ambulance Service and its staff should be able to see it. If something needs to be done on that, Jackie Baillie has my assurance that we will seek to do it.
As I started at the end, I will work backwards through the questions. On the telephony arrangements, the Ambulance Service is working closely with BT to seek to address some issues that have been experienced with its telephony systems, and I am kept closely informed of that work. I am sure that Jackie Baillie knows that robust contingency arrangements are in place, as we would expect, but any occasion on which the Ambulance Service’s telephony or computer systems do not work as we would intend is a matter of concern and is taken seriously by me and the Ambulance Service.
On the overtime budget, Jackie Baillie is probably referring to my recent answer to a parliamentary question. I think that everybody would agree that overtime budgets should be kept to a minimum. However, response times are paramount, and the Scottish Ambulance Service is monitored closely and publicly in that regard. It is also important that staff feel that they are properly resourced to meet the response time targets that we set. I seem to be on a roll with giving assurances, but I am happy to assure Jackie Baillie that I will continue to scrutinise, as I always do, the Ambulance Service to ensure that its staff are properly resourced and that it is meeting its obligations to the public, which is what this is all about.
I also welcome the statement and thank the cabinet secretary for advance sight of it, although I did get advance sight of the announcement on the BBC website yesterday afternoon.
The subject of the statement is a serious issue that has needed resolution for some time. We have raised it on a number of occasions, including at First Minister’s question time on 9 June, when Annabel Goldie raised the matter. There is concern that it has taken time to resolve it. That said, I welcome the interim solution that has been set out today.
The cabinet secretary said that the majority of the unions involved have accepted the interim offer. I understand that the GMB has not done so. Can the cabinet secretary tell us how many workers are not signed up to the interim offer and what impact that will have? What assurances can she give us that at the end of the three-month period there will be a permanent solution, given that there have been two failed attempts to reach a resolution?
I acknowledge that Annabel Goldie raised the issue in Parliament. I think that we all wish that the situation had never arisen—it dates back to 2004—and that we had managed to find a solution to it more quickly. The lack of solution has not been for the want of trying; often such things have to be worked through. We have reached a good interim position and I am determined that a longer-term solution should be put in place at the end of the interim arrangements.
Murdo Fraser was right to say that at this stage the GMB has not agreed with us on the way forward—as is its right, which I do not question. Unite and Unison have agreed the way forward. I put on record my thanks to all the unions for the constructive way in which they have conducted themselves.
It is not a question of staff signing up or not signing up to the interim arrangements—they are not voluntary. What we have had in place up to now was a voluntary arrangement, but the interim arrangements over the next three months will apply to all staff in the categories that I set out in my statement.
We move to back-bench questions to the minister. I remind members and the minister that questions and answers should be brief, so that we get in as many people who want to ask a question as we can.
I welcome the cabinet secretary’s statement. No doubt she shares the widespread disbelief at the death of a 33-year-old woman 750m from an ambulance base because the ambulance man who could and should have driven to her rescue refused to do so because he was on a break. A life was at stake.
The Scottish Ambulance Service will now greatly enhance payments to ambulance crews on the very rare occasions on which they are called to provide emergency assistance during rest breaks. Does the cabinet secretary agree that, although rest breaks for crews are important, it is critical that the public know that in an emergency they will be the Ambulance Service’s absolute first priority?
Kenny Gibson can take from my statement that I agree that patient safety is paramount. However, I repeat what I said: staff on rest breaks are abiding by their contract of employment. It is important to say that. A lot of the commentary that has been directed towards ambulance staff recently has been unfair to staff, who have been abiding by their contract of employment. The problem is with the contract, not with the dedication or commitment of our ambulance staff. I wanted to put that on the record.
The second point that I want to put on record is that it is essential that we give rest breaks to ambulance staff. The health and wellbeing of our staff in any part of the health service and particularly in our emergency ambulance service are critical, not only for the staff but for the public. Members of the public want to be assured that the member of staff who attends to them in an incident not only will attend quickly but will be fit for the job. That is why rest breaks are important. A key part of what I am announcing today is a guarantee of continued rest breaks.
I welcome the good statement by the cabinet secretary. The case in Crieff to which she referred involved a constituent of mine and of Gordon Banks.
Will the cabinet secretary provide a guarantee that the standard operating procedure will not in any way involve a return to one-person-manned ambulances as a way of coping with the breaks issue? Will she also look at ensuring that all publicly accessible defibrillators are known to the Ambulance Service, so that if an appropriate event occurs SAS can tell the member of the public who called 999 where the nearest defibrillator is? Such an approach is taken in a number of areas but is not yet taken throughout Scotland.
Richard Simpson’s point about defibrillators was well made. Mapping work is being done and it is important that the Ambulance Service knows where publicly accessible defibrillators are. I cannot remember whether Richard Simpson was in the chamber earlier this afternoon when a question on defibrillators was asked—
I was.
In that case, he will have heard Michael Matheson’s answer.
I give Dr Simpson an absolute assurance on the single-manning issue. There will be no return to routine single manning in the Ambulance Service. I am proud that we worked to ensure that single manning was eradicated, and we will not go back on that.
I think that I saw Jackie Baillie look askance when I used the word “routine”—
The cabinet secretary is imagining things.
Maybe I did not see her do so. Just in case, I should say that last-minute events will always crop up that will make certain arrangements unavoidable. However, single manning is not acceptable, and we will continue to work with the Scottish Ambulance Service to ensure that it does not happen.
Can the cabinet secretary provide an update on the work that has been carried out by her, the Scottish Ambulance Service and others to deliver a retained ambulance service in Braemar?
I know that the member has a great interest in Braemar. All members who represent the north-east of Scotland will be aware of on-going efforts by the Scottish Ambulance Service and the community of Braemar to establish a retained ambulance service, similar to the scheme that is in operation in Shetland.
Last October, I met local MSPs, the Scottish Ambulance Service and community representatives to facilitate discussion of how that could be pursued. Despite the considerable efforts of all involved and the enthusiasm of the community council, attracting the volunteers that are needed to support the scheme has been challenging. However, I have offered to convene a further meeting so that we can maintain momentum. My office is currently in the process of setting that up.
Does the cabinet secretary recognise that ambulance crews in rural areas might deal with a dozen call-outs a week, while those in cities, such as Edinburgh, might deal with 10 call-outs in a shift? What assurances can she give us, in light of the cuts to the overtime budget, that there are simply enough staff in Edinburgh to do the job?
I think that most people would recognise that there is a significant difference between the demands that are placed on our ambulance services in rural areas and those that are placed on the ambulance services in the centre of Edinburgh, Glasgow or any city. In its operational approaches, the Scottish Ambulance Service has a duty to ensure that it takes those differences fully into account. We have just been talking about single manning, which was a particular challenge in rural Scotland, but there are other challenges in urban Scotland. I have already spoken about the overtime issue.
The Scottish Ambulance Service has an absolute responsibility to ensure that the ambulance services are resourced to meet their obligations to the public and their staff in delivering those services to the public, and I have an obligation to ensure that it does so.
I note the cabinet secretary’s assurance that the new arrangement will be invoked on rare occasions only. The Scottish Ambulance Service has a duty of care to its staff and adequate resources must be set aside. Therefore, will the cabinet secretary guarantee that she will monitor the allocation of resources to relief crew staffing levels?
I would also like to point out that remote and rural crews face quite different pressures from those faced in urban areas, in terms of the distances that they need to travel. Can the cabinet secretary assure me that the monitoring that she will carry out will capture geographical differences?
Yes, it will capture geographical differences. As I said in my statement, the weekly reports will come from every control room to the Scottish Ambulance Service, and I will see those reports.
On resources, I did not say this in my statement but it is worth pointing out to members that the additional resources that the interim arrangements necessitate will be provided as additional resources by the Government to the Scottish Ambulance Service. That is appropriate.
We will continue to take whatever steps we require to take to ensure that the Scottish Ambulance Service is resourced to do the job that it has to do.
The cabinet secretary will be aware that, in some cases, ambulances have struggled to locate properties, particularly in rural areas. Will the cabinet secretary provide a bit more detail about how ambulances are matched with call-outs and what steps are being taken to improve that?
I am aware of that issue and it was specifically raised with me by the family in Crieff whom I mentioned before.
There have been cases in which ambulances have struggled to locate properties. In light of that, the Scottish Ambulance Service has identified that there is room to improve the resilience of its mapping system. It is currently establishing a service-level agreement with the Improvement Service, which holds an address database made up of 32 individual local authority gazetteers. That will ensure that the service holds the most up-to-date address information possible. In addition to that, it is refreshing guidance to front-line staff, including staff in emergency medical dispatch centres, on the need to ensure that mapping systems are kept up to date at all times, using information from the Ordnance Survey, supplemented with information from less formal systems that can equip the staff with more local knowledge. The issue is very much on the radar screen.
Like my colleagues, I warmly welcome the cabinet secretary’s efforts to resolve an issue that greatly concerns all members in the chamber. Given that we are moving from a voluntary system to a mandatory system, does the cabinet secretary have figures for the projected costs—based on historical costs—that she can share with members this afternoon? I recognise that, given the complexity, it is very much a demand-led budget, and as such it is difficult to make predictions.
Has comparative work been done on how Wales, Northern Ireland and the Republic of Ireland manage what is not an easy situation?
The Welsh model has been held up as a possible solution, but on further examination I am not sure that it has found the magic solution that has evaded us. We will continue to look at that, and I am sure that the Ambulance Service management and the unions will continue to examine the experience in other parts of the country to see whether anything can be learned.
On the costs, I am happy to share details with Parliament in the fullness of time. However, I have announced today an interim arrangement and talks are on-going, so it is probably better to let those proceed and see where they take us without being definitive at this stage about the money that might or might not be available.
The Scottish Government is working with the Ambulance Service. We will fund the interim arrangements and continue to ensure that the service is appropriately resourced to implement whatever long-term solution emerges from the on-going talks.
Given the cabinet secretary’s detailed knowledge of the situation, how hopeful or confident is she that a sustainable solution—that the union membership buys into—will be reached in the next few months?
I thought—and still think—that the offer that was put to staff in the summer was fair and reasonable, but I must recognise that significant majorities in all three unions took a different view. It is right that the talks continue, and I do not want to pre-empt them. We must find a solution that puts patient safety at the top of our list of concerns and recognises that the status quo before implementation of the interim arrangements was not in the interests of ambulance staff.
I am confident that with the co-operation of management, the Government and the unions, it is possible—indeed, it is essential—to find a way through the issue.
I welcome the cabinet secretary’s statement, given the death in Tomintoul last year, which shocked the local community. If the number of ambulance service call-outs during rest breaks for the 540 staff who signed up to the voluntary scheme in 2010-11 is similar throughout Scotland, as is likely, is there any reason why the average figure—fewer than four times per individual per year—is likely to be an underestimate?
I have asked to see the weekly reports partly to answer such questions. It will be important to see how the arrangements are implemented in practice and what the impact is. I cited the figures for the last year to give some context to the debate, and to add force to my point that I would expect the arrangements to be invoked only on rare occasions.
I repeat what I said earlier: staff are entitled to a rest break, and it is therefore important that the Ambulance Service does not abuse the arrangements or use them unnecessarily or inappropriately. The activation payment is an important part of that. It will not escape the notice of any member in the chamber that if the Ambulance Service has to pay £100 on too many occasions, financial pressures will be placed on it. The payment has deliberately been set at that level to ensure that the arrangements are invoked only on rare occasions.
As a list MSP for Crieff and a resident of Comrie I am well aware of the very sad case of the Gray family, and I welcome the cabinet secretary’s statement. In order to ensure operational efficiency and to maintain public confidence in our ambulance service, will she consider publishing the standard operating procedure that is to be introduced?
I am certainly happy to discuss that with the Ambulance Service. I am not sure whether there is any reason why the document could not be published. The document is technical but, unless I am told of a good reason after this session why it cannot be published, I will be more than happy to ask the Ambulance Service to make it available.