Orkney Air Ambulance Service
The final item of business today is a members' business debate on motion S3M-331, in the name of Liam McArthur, on the air ambulance service in Orkney.
Motion debated,
That the Parliament notes the continuing concerns felt in Orkney about the provision of air ambulance cover in the islands, the validity of which were demonstrated by the recent failure of the Scottish Ambulance Service helicopter to evacuate a patient from Papa Westray because of the weather conditions, with the patient only being evacuated thanks to the co-operation of the pilot of a Loganair BN Islander who was able to use his local experience of the weather to make use of a short weather window to reach the island; further notes that this would not have been possible had the evacuation been needed outside Loganair's operational hours; believes that an independent review of the provision of air ambulance cover in Orkney is urgently needed, and further believes that the outcome of such a review would be the recognition of the need to provide a Kirkwall-based BN Islander air ambulance to provide a back up to the main Scottish Ambulance Service aircraft.
I welcome this opportunity to debate an issue that is absolutely critical to my constituents. It is no exaggeration to say that it is potentially a matter of life or death to them. It is not a new issue, of course—my predecessor, Jim Wallace, secured a similar debate in February last year. I pay tribute to his tireless efforts in keeping the issue front and central, and very much in the in-trays of Scottish ministers.
Despite the widespread and deeply felt concerns of my constituents, despite the worrying stream of cases that have exposed shortcomings in the current air ambulance provision, despite the concerns that have been raised by island general practitioners and nurse practitioners with first-hand experience—too often bad—of the current service, there remains an unwillingness to recognise my constituents' right to the level of service that is enjoyed by people who live in almost every other part of the country. As with any such service, the aim must surely be to allow patients who are in need of medical attention—whether or not it is a life-or-death emergency—to be taken to the appropriate hospital without undue delay.
For that to happen, it is essential that we have an ambulance service that is designed to cope with weather conditions, in Orkney in this case, day and night, summer and winter. It is clear—and it was predicted—that the Inverness-based EC 135 helicopter alone cannot provide that service. The limitations of the helicopter were set out in detail during last year's debate—in colourful and persuasive fashion, if I may say—by the current Minister for Transport, Infrastructure and Climate Change. As Stewart Stevenson explained, in certain weather conditions, particularly when there is icing, that helicopter cannot fly—conditions that did not prevent the previously used Islander aircraft from flying.
The issue is about more than just the relative capabilities of types of aircraft. Orkney weather changes fast, as I well know, but a Kirkwall-based pilot who is familiar with the weather patterns can make use of short weather windows, whereas an Inverness-based pilot cannot. An Inverness-based pilot might be prevented from flying by weather to the south of Orkney, which would not affect a Kirkwall-based pilot. Today's motion gives an example of just that vital point. On a day when the helicopter could not reach Papa Westray, an Islander, on its scheduled flight in the north isles, was able to use short weather windows to get in and out of the island safely, and it got the elderly patient to hospital.
Although the issue remains the same as it was when Jim Wallace secured his debate last year, there has been a significant change over the intervening months. Since that time, the communities that are affected have completely lost confidence in the service. I am well aware of that, having visited and spoken to constituents in each of the outlying islands. The issue was reflected starkly in a recent petition, which attracted more than 1,200 signatures from across the north isles—a staggering figure considering the overall population of the islands. It is a message that the convener of Orkney Islands Council, Stephen Hagan, and I passed on, along with the petition, to the new chief executive of the Scottish Ambulance Service, Kevin Doran, when we met him last week.
Emotions are running high, and it is not difficult to see why. The communities on those islands are tight communities, but they feel vulnerable. Islanders see at first hand the risks to themselves, to their families and to their friends and neighbours. They also recognise the difficulties with attracting people to and retaining them on the islands. The issue goes well beyond emergency health provision; it challenges the fundamental economic and social viability of small island communities.
It is perhaps invidious to pick out individual cases on individual islands. As I have said, the concerns are felt equally strongly across all the islands. However, the case in Westray last month vividly highlighted the inadequacies of the current air ambulance provision. It shocked the entire community in Orkney and so angered the local GP that he spoke out in unprecedented terms—"Some will die." That is a direct quote from the Westray doctor, Pedro Ponte. It was also, unsurprisingly, the headline in The Orcadian on 15 November. I know that the case has been brought to the minister's attention by the council convener, who is a resident of Westray, and that it is the subject of a formal complaint by Dr Ponte to the SAS.
For the benefit of members, I will highlight briefly some of the details of the case—which is the worst but, sadly, by no means the only case in recent times. A severely disabled woman with acute pneumonia was left to travel alone on a delayed air ambulance flight. Her parents—the only people present who were able to communicate effectively with her—were denied space on the helicopter because of the weight restriction. The emergency helicopter was requested within two hours. After some delay and various phone calls, it was promised within six hours. It eventually arrived more than seven hours after the initial call from Dr Ponte—a further delay that resulted in the woman spending well over an hour in the back of an ambulance at the airfield in the middle of the night.
Does the member acknowledge—this has been part of the correspondence that we have had on this case—that one of the important issues was the lack of communication of the facts of the case and about how urgent it was? Does he further acknowledge that it is absolutely crucial that communication between all parties in such cases be as good as it can be?
I certainly do not dispute the need for the best possible communication. There are also concerns about the way in which the data in relation to individual cases have been gathered—I will turn to that shortly.
Dr Ponte has described the situation as "a disgrace". He is absolutely right, but that is not to say that the pilot or the paramedics were at fault—quite the contrary. Their actions have been rightly praised by Dr Ponte, Stephen Hagan and others who were involved that night. However, as Dr Ponte said:
"This is Scotland—if you run an air ambulance service, you have to run it in bad weather. If you cannot do that, do not pretend to run a service."
I have heard what the Scottish Ambulance Service and ministers have said, but I know what is happening on the ground: I know the concerns that are felt locally, including among the medical professionals in the islands, and I know the distrust in Orkney about what we are told by the SAS. Statements that were made by its previous chief executive in public meetings in Orkney undoubtedly contributed to that breakdown in trust. The assertion by Adrian Lucas that use of the Islander for air ambulance flights was prohibited under health and safety regulations proved to be groundless, as did his claim that as a result of the tragic crash off Campbeltown in 2005, the Civil Aviation Authority had accepted a recommendation that single-pilot air ambulance flights be banned.
Such economy with the truth damaged the reputation of the SAS in my constituency. However, I am encouraged by the approach that Kevin Doran has taken since he took over from Mr Lucas last month. He accepted my request for an early meeting along with Stephen Hagan and although he offered no guarantee of an immediate change, he did undertake to review a number of cases, including the one in Westray to which I referred, before coming to Orkney in the new year for meetings with isles GPs, nurses and other stakeholders. I hope that that signals the beginning of a change of attitude and, ultimately, a change in how the service is provided.
The case for change is unanswerable. I was therefore pleased to see the newly appointed chair of Orkney NHS Board, John Ross Scott, accept that
"there are still concerns that need to be addressed",
which he plans to raise with the SAS board. As the former editor of Orkney Today, which, like The Orcadian, has done much to campaign on the issue, Mr Scott's comments are welcome.
I have outlined the serious, widespread and compelling concerns of my constituents. During the previous debate on the subject, Jim Mather said:
"If tonight's debate is about anything, it is about a request to have those concerns properly and fully addressed."—[Official Report, 23 February 2006; c23578.]
Tonight's debate is about the clamant right of my constituents to an air ambulance service that is at least as good as what they had before. I, local nurses, GPs and my constituents believe that that requires the restoration of a locally based back-up to the Inverness helicopter. I hope that the minister will heed those calls and respond positively. I look forward to the speeches of other members.
I had the pleasure of taking part in the previous debate on this subject. We can see that things have moved on and I congratulate Liam McArthur on securing the debate.
It is clear that the air ambulance situation in Orkney is totally unacceptable and unsatisfactory. The Scottish Ambulance Service's provision of air ambulances has to be reviewed urgently and the cases in Orkney are the prime reason why that should happen, although cases from elsewhere add to our concerns. Under the previous management of the SAS, we got less than the truth. I believe that it is now possible for the SAS to see things more clearly.
I echo Liam McArthur's view that the cross-party meeting in Inverness dealing with matters relating to the Highlands demonstrated a new openness and recognition of the problems by the SAS. The service is a small part of the national health service and it is not easy for it to make its voice heard. However, I point out that, Highlands NHS Board had to spend an extra £20 million on trying to cope with the agenda for change. It might have been far better if we had a funding structure that was organised for Scottish needs and allowed some of that £20 million to be spent on air ambulance provision.
Increasingly, the air ambulance is seen as a way of dealing with the issues of the islands and remote Highland communities, which means that air ambulances will be used more often in the future. If that is the case, we must ensure that the kind of helicopters that are being used and the practice of relying on Loganair aircraft for back-up are reviewed. The helicopters that are being used at the moment can take two patients, which means that there is a restriction on folk travelling with patients, which is terrible for someone who needs to be accompanied, such as the person in the situation that Liam McArthur described.
In relation to that example, and others that we could give, it is important that we ask for a review that would allow for the back-up that has been talked about. It is not good enough for us to rely on a helicopter that is flown by someone who has some local knowledge, because all helicopters are subject to the same restrictions on when they can fly. It is essential that fixed-wing aircraft be available. The alternative is the old-fashioned option: that would mean a lifeboat, which is unacceptable in this day and age.
I echo the cross-party outrage about how people in the Orkney Islands have been treated. I support the suggestion of a review and hope that the minister can help us by ensuring that the Scottish Ambulance Service conducts that review early.
I congratulate Liam McArthur on securing this important debate and on his speech, which was as articulate and well crafted as usual.
I am happy to support and endorse Liam McArthur's campaign. He can be assured of not only my support but that of Margaret Curran, the shadow health team and others.
Many years ago, when I worked on the frontline of social services and community care, I was in day-to-day contact with health services. In my view, there is no issue relating to an agency or a delivery body that is of more immediate importance to the public than health. Academics have, rather grandiosely, described this as Maslow's hierarchy of needs. You will be glad to know, Presiding Officer, that I will not quote Maslow again in the debate. Perhaps an easier way of understanding the point is to think of an example of an elderly woman, living isolated and alone in Kirkwall, who is in pain and in need of urgent medical attention. There are no prizes for guessing what issue would be first, second and, indeed, last on her list of concerns.
I was going to talk about the front page of The Orcadian, but Liam McArthur has beaten me to it. I will bow to his local knowledge and experience.
I think that everyone in the chamber is united around the solution to the problem that has been raised. Certainly, my view is that there should be a locally-based air ambulance. I hope that, when she winds up, the minister will talk about the possibility of a review of the situation. Perhaps the new chief executive of the Scottish Ambulance Service will go back home and think again about the issue. I know that Orkney Islands Council convener has taken a strong initiative on the issue—as has the council itself.
As we all know, Loganair previously had the Orkney air ambulance contract, with a fixed-wing aircraft at the hangar in Kirkwall. At that time, there was a crew available, which ensured that medical evacuations could be carried out quickly and efficiently. Now, with the air ambulance service based in Inverness, there are real worries. As I think Rob Gibson mentioned earlier, there are times when a helicopter cannot fly, because of icing, but a fixed-wing aircraft can. I am sure that we need Stewart Stevenson to explain the technicalities of the matter—I bow to the knowledge that he displayed on the matter in the previous debate on this subject.
There are also issues concerning refuelling, to which Jim Wallace and Alasdair Morrison referred in the previous debate. If a helicopter is going from Inverness to Orkney and then to Aberdeen, it will need to refuel. That is a big issue in relation to patient care.
The public on Orkney feel very vulnerable about the issue, and there are longer-term concerns about whether it might even lead to some depopulation. That concerns me and, I am sure, all members in the chamber. The public need to have confidence in our emergency health care provision.
I do not think that I can sum up the issue better than Stewart Stevenson did in the previous debate, when he said:
"The issue is where the aircraft is, not what it is, and the aircraft need to be near the patients."—[Official Report, 23 February 2006; c 23586.]
I strongly agree with that statement—we need a locally-based air ambulance, and we need it now.
I thank Liam McArthur for the debate and for lodging the motion, which sums up the concerns and the experience of people who live on Orkney and reminds us of how much we miss Stewart Stevenson's comments about aircraft.
In a written answer to Liam McArthur on 6 December, the Minister for Public Health stated:
"I see no need to commission an independent review, but we will continue to monitor the performance of the air ambulance service".—[Official Report, Written Answers, 6 December 2007; S30-1574]
However, in written answers to other questions about air ambulance delays due to adverse conditions and shift changes, the minister states that the "information is not collected." It must be very difficult, if not impossible, to monitor any service accurately when crucial information is not collected and the experience of people who live on the islands that is giving rise to the main concerns that we have heard about tonight is ignored.
I will consider some general points on the air ambulance service before I come back to the service in Orkney. Despite many calls from MSPs across the chamber, it took eight weeks for the Scottish Ambulance Service to meet members such as Rob Gibson and me to discuss issues such as single manning. At today's meeting of the Health and Sport Committee, I was quite surprised to learn that of the four community health partnerships represented, none had a representative from the ambulance service on their management board.
The ambulance service is not yet fully integrated into the national health service, and more needs to be done to value the commitment of ambulance personnel and to ensure that the service is seen not as an add-on to the NHS or as a transport service, but as a fully integrated part of the NHS, NHS 24, GP services and community health partnerships.
In the document, "Better Health, Better Care: Action Plan", which was published today, one of the health improvement, efficiency, access and treatment targets is
"To respond to 75% of Category A calls within 8 minutes from April 2009 … across mainland Scotland."
That is a very reasonable target. However—and I am not sure whether I have got this right—there is no target for island communities. In the same edition of The Orcadian that has already been mentioned, Dr Ponte said:
"I requested an air ambulance within two hours as it was an emergency case."
It was an emergency—so he wanted it in two hours. Surely we are not saying that eight minutes is okay on the mainland, but two hours is okay on the islands—in fact, in that example, the air ambulance took closer to seven or eight hours. We need to be concerned about that.
It is worrying that the trial period for the current service in Orkney—which ended in 2006—has resulted in a service that does not carry the confidence of the local community. I do not have evidence to support this, but I presume that local people raised concerns during the trial period that should have been taken into account.
It is doubtless very worrying, particularly for people who are not in the best of health, when an emergency category A call takes two hours and when there is no GP back-up on the islands—or on some of the islands. The situation also raises concerns—I know that this is an issue in Orkney—about the removal of a GP from other islands.
In a discussion that we had this week with the ambulance service, the management told us that the air ambulance will be used more extensively across the Highlands. Given that a helicopter can be in only one place at a time, if it is to be used more extensively across the Highlands, I am not sure what that will do for response rates in Orkney.
I support the request for a review and I endorse the points that Liam McArthur made.
I congratulate Liam McArthur on bringing such an important subject to the chamber for debate. As another Highlands and Islands member, I am aware that people on other islands, as well as those on Orkney, are worried about air ambulance provision. People on the Isle of Mull have been worried about the issue for some time.
Order. I say to the member that he must address the content of the motion, which is fairly specifically about Orkney. I hope that he will bear that in mind.
I certainly will.
Although helicopters are a useful tool, there is no doubt that their inability to fly safely in certain weather conditions can put vulnerable patients in grave danger and could cause avoidable deaths. What is needed, as Liam McArthur said, is a fully operational, local back-up service to the existing helicopter service. I fully expect that that will cost more money, but saving lives is paramount and all eventualities should be catered for if the means exist to do so.
I welcome Liam McArthur's motion and the opportunity to discuss the Scottish Ambulance Service's air ambulance service, and particularly the way in which it provides services to the people of the Orkney Islands.
Although I accept that improvements can always be made, we should take pride in our air ambulance service, which is the only publicly funded air ambulance service in the United Kingdom and is one of the most advanced services in the world. Despite the cases that Liam McArthur raised, to which I will come in a moment, the service provides a high-quality, safe and responsive service, day in, day out, across Scotland. The service that we are debating has been delivering on its performance standards across the NHS board areas. I will highlight some of those standards.
Last year, the average response time to calls in life-threatening situations was 9.5 minutes, compared with the Scottish average of 8.9 minutes. The performance against the time factor that is agreed with the referring clinician improved from 83 per cent in 2004 to 91 per cent in 2007. To put that in context, in 2007, the air ambulance did not meet the agreed time factor on three occasions: two missions from Stronsay were six minutes outside the agreed two-hour time band and a mission from Westray was five hours outside it. In the latter case, the helicopter was delayed due to the weather, and although the ambulance service offered the coastguard aircraft, it was declined, because the patient was stable. As Liam McArthur rightly said, the new chief executive of the Scottish Ambulance Service, Mr Doran, said that he will look into the circumstances of the case.
We need to address the lessons that arise from the handling of all air ambulance service incidents. As I said in my intervention, it is crucial that we have clarity about the nature of the response that is required and the need for continuing communication about the service that is provided.
Does the minister accept that the concerns that have been raised about the way in which data are collected cast into doubt the veracity and robustness of some of the figures that she quoted? Also, does she accept that the genuine and deeply held concerns of GPs and nurse practitioners suggest that the responsiveness of the air ambulance service to their medical judgments is perhaps not as it should be?
I always take seriously any such concerns, whether they come from the public or clinicians and other health professionals. I am more than happy for Mr Doran to examine those data along with the other issues that he is considering.
I suggest that occasions on which the advice from air traffic control is that the weather is below the minimum safe operating standard and the decision is taken to postpone a mission until the weather has improved or not to carry it out should not be challenged lightly, no matter where an aircraft is based.
Members have mentioned GPs' concerns and the assertion that they are being pressured into agreeing to more relaxed evacuation times than they consider desirable. It seems, however, that GPs are requesting that more patients be responded to within shorter timescales, and that the ambulance service has responded to such requests.
The air ambulance service controller is responsible for making the best use of the air resources that are available, against the background of the competing demands that may exist at any given time from clinicians throughout Scotland. Ultimately, however, we should remember that it must be the clinician who is caring for the patient at the scene who determines the timeframe for the air ambulance evacuation that will best meet the patient's needs. If the clinician believes that the patient requires to be transported more quickly than the air ambulance service can undertake—whether due to the weather or other pressures—the option exists for their request to be upgraded and for the Ministry of Defence, coastguard or, in some cases, a lifeboat to be called on to carry out the mission instead.
I am grateful to the minister for taking another intervention.
Her last comment is pertinent to the point that David Stewart made in quoting Stewart Stevenson. Orkney is the only place that does not have a locally based air ambulance option as a back-up. Calling on coastguard helicopters and lifeboats is a sub-optimal option. Having a locally based back-up would address all the issues and concerns that have been raised.
I will come on to that, but weather is important—the same situation could occur with a locally based aircraft.
The Scottish Government is not complacent. We know how important it is to secure public confidence in service provision throughout Scotland, and in particular in remote and rural areas such as the Orkney Islands. Liam McArthur made that point well, and I agree with it.
I know that Mr McArthur recently met Kevin Doran and that Mr Doran is keen to work with Mr McArthur and the people of Orkney more generally to try to address their concerns about service provision. I welcome Mr Doran's commitment to sit down with Orkney GPs and other relevant stakeholders to go over the service records for all the 41 inter-island ambulance service missions that have been carried out since the beginning of April. That engagement is critical if we are to find a way through the claims and counterclaims about the performance of the service in Orkney.
The Cabinet Secretary for Health and Wellbeing and I regard public confidence as an indicator of the quality of service provision. The prospect of service change can be unsettling, and it requires to be handled with great sensitivity. I am aware of the current uncertainty of communities in the outer isles of Orkney as the health board develops its creating sustainable services programme. However, I assure Mr McArthur and his constituents that the Scottish Government, NHS Orkney, Orkney Islands Council and the Scottish Ambulance Service all recognise the critical interdependence between local clinical service delivery and the transport infrastructure. The considerations in the creating sustainable services programme will require all those partners and the local communities to work closely together to ensure that any proposed service change can be supported by sustainable and affordable transport services that will guarantee patients access to unscheduled care services when required.
The air ambulance service currently carries out around 50 non-emergency patient transfers each year from the outer isles of Orkney. Liam McArthur has talked about his desire for an Orkney-based aircraft to be reintroduced. I re-emphasise that, at present, when those missions cannot be carried out by the air ambulance service-contracted aircraft, back-up measures exist. I do not dispute the fact that many of those missions could be carried out by a dedicated aircraft based on mainland Orkney, but nearly all of them are carried out by the ambulance service's EC135 helicopter within the agreed performance standards, therefore I have some difficulty in seeing what benefit an additional back-up aircraft would bring to those missions. That said, I look forward to the chief executive's review of the 41 missions from the outer islands.
Will the minister give way?
The minister is winding up.
I invite members to take account of the fact that, of the 16 populated islands that we are talking about—and if we exclude South Ronaldsay—only six have landing strips or other landing provision for a lightweight fixed-wing aircraft such as the Islander. We should remember that the remainder depend on a helicopter response or, in some circumstances, a lifeboat response. The EC135 and the MOD and coastguard helicopters do not require a landing strip and can therefore access several islands that the Islander cannot reach.
I look forward to progressing the issues with the Scottish Ambulance Service's chief executive. He has made a commitment to consult more widely and to examine all the incidents and the data to which Liam McArthur referred. I hope that, in the spirit of co-operation, we can all move forward from that.
Meeting closed at 17:46.