Scottish Ambulance Service
The next item of business is a statement by Nicola Sturgeon on the Scottish Ambulance Service. The cabinet secretary will take questions at the end of her statement and there should therefore be no interventions or interruptions.
In the debate on 22 May, members raised a number of concerns about the Scottish Ambulance Service. I undertook to investigate each and every one of those concerns and, on 4 June, I reported back to the Parliament on the actions that were being taken to address them. I gave a commitment then to come back to Parliament after the summer recess with a further update on progress.
In the interests of consistency, I intend to structure my update around the same four issues that I covered on 4 June. They were: leadership culture; the accuracy and reliability of performance data; concerns about the use of fast-response vehicles; and staffing issues, with particular reference to single crewing.
Concerns about the leadership culture in the Scottish Ambulance Service were first brought to the attention of the Scottish Government and the Scottish Ambulance Service in May, when formal complaints, including serious allegations of bullying and harassment, were made. At that time, the service's board asked Ken Corsar to chair an independent investigation. That investigation has been concluded, and a report has been submitted to the chair of the Scottish Ambulance Service. It remains a matter for the service's board, but I am assured that due process has been and will continue to be followed. Members will understand why I will make no further comment on the issue today, to ensure fairness to all concerned.
Members will recall that concerns were expressed about possible manipulation of performance data and that there was a suspicion that the recent improvement in performance against the category A target might be the result of such manipulation, rather then genuine service improvement. I confirmed that I had instructed a comprehensive review and audit of the performance information that was required for reporting on the target. The review was led by Professor Peter Donnelly, the then deputy chief medical officer, and was supported by representatives of the Scottish partnership forum, the Scottish Government health directorates and ISD Scotland, and by a director of operations from an English ambulance service trust.
I have received Professor Donnelly's report; copies have now been made available to health spokespeople and placed in the Scottish Parliament information centre. I am pleased to advise members that the report finds no evidence of inappropriate data manipulation in the Scottish Ambulance Service. Professor Donnelly emphasised that he and the group attach a high degree of certainty to that conclusion. He advised that the group received full co-operation from both staff and management of the service and benefited from an external data audit that confirmed the group's findings.
However, the report identifies data-handling, management and audit processes that, in the group's opinion, were not sufficiently robust or were not always applied universally in the organisation. It points to the need for an external validation process to be developed and applied to the data that the service produces before performance information is reported to the Scottish Government. The Scottish Ambulance Service agrees with the report's conclusions and is already taking action to address the recommendations.
If there has been no data manipulation, how has the service achieved the service improvements that are reflected in the category A performance figures? The group concluded that there were credible explanations for the reported performance improvement. The report maps out an 18 per cent category A performance gain by the service between December 2006 and May 2008 and describes the various operational areas in which improvement has been made. The factors that it identifies include improvements in allocation and mobilisation times in the emergency medical dispatch centres and ambulance deployment points; improved basic performance flowing from investment of more resources and the better deployment of ambulances; and the introduction of auto-reporting at scene.
I appreciate that auto-reporting at scene—which, the report estimates, may account for about 4 per cent of the reported performance improvement—causes members some concern. Due to the 200m tolerance of the vehicle location system, it is possible for an ambulance to be recorded as at scene slightly before it is there. It should be pointed out that that was, and is, possible under the manual system and that auto-reporting is used by all ambulance services. Nevertheless, the report rightly recommends that the service identify opportunities to refine the system's tolerance to improve further the accuracy of reporting.
I hope that the detailed, thorough and extremely robust report that has been produced satisfies members' concerns and reassures them that there has been no manipulation of performance data by the Scottish Ambulance Service. My officials will continue to work with the service to ensure that all the report's recommendations are taken forward and that the required improvements in process are put in place quickly.
In my statement to Parliament on 4 June, I confirmed that I had asked the chief medical officer, Dr Harry Burns, to commission an independent evaluation of the front-loaded model. Dr Burns tasked NHS Quality Improvement Scotland, under the guidance of a reference group, to undertake the review. The QIS report has been published on its website, and copies have been made available to members.
The report is clear that the use of fast-response vehicles for responding to appropriate emergency calls is valid and that the principles of the front-loaded model are sound. It recommends that the Scottish Ambulance Service should continue to develop the use of fast-response vehicles as part of its service to meet the clinical needs of patients. It also makes a number of recommendations on the more effective implementation of key principles, including clinical governance, appropriate training and proactive engagement with the public, Scottish Ambulance Service staff and other parts of the health and emergency services.
Taking forward all those recommendations will allow the Scottish Ambulance Service to deliver clinically effective, patient-centred care while addressing the concerns of staff about safety and governance. In the interests of public assurance, however, I have asked the chief medical officer to commission, in six months' time, a further report on how the service is progressing in its utilisation of fast-response vehicles. That report will of course be published, and I have no doubt that it will be the subject of debate by members of the Parliament.
I have made clear to the Scottish Ambulance Service my firm expectation that fast-response vehicles should always be crewed by a paramedic, unless there are exceptional circumstances. In response, the service has confirmed to me that, by the end of this calendar year, the rostered crewing of fast-response vehicles by technicians will be eliminated.
I turn to staffing and related issues. Members are aware that the Scottish Ambulance Service faces a number of challenges flowing from the introduction of the new agenda for change pay, terms and conditions package. In particular, the implications of the new United Kingdom-level agreement on how staff who work unsocial hours should be remunerated caused some difficulty for the service. In addition, some areas of the agenda for change agreement, such as the provisions on meal breaks and on-call arrangements, have presented real and significant challenges.
Scottish Government officials have been discussing all those issues with Scottish Ambulance Service management and trade unions. I am confident that all parties will, in the near future, be able to reach agreement on a way forward that is right for the Scottish Ambulance Service and its staff and which is also in the clear interests of patients. I will, of course, keep members fully updated on that set of issues.
That leads me to the final substantive issue that I wish to deal with today: the elimination of rostered single crewing of traditional accident and emergency ambulances. When I last reported on the issue to members, I made it clear that I expected the Scottish Ambulance Service to take action to eliminate rostered single crewing. I asked it to provide me with an action plan demonstrating how it intended to achieve the elimination of single crewing on a sustainable basis. I have now received that action plan, and copies have been made available to members today.
It is clear that delivery of the action plan will require significant additional investment. I am therefore delighted to announce to Parliament that the Scottish Government will provide an additional £4.7 million to the Scottish Ambulance Service over this and the next two years. That investment will support the recruitment and training of an additional 40 front-line staff into the north and south-west divisions of the service. That will result in a significant increase in the relief capacity at which the service is able to operate, and it will ensure that single crewing is eliminated in all but the most exceptional and unforeseen circumstances. The service has advised that, realistically, it might take around two years to have all the staff who are required in post and fully trained. In the medium term, therefore, additional overtime resources will continue to be made available to keep the incidence of single crewing to a minimum.
I am pleased to report that that investment is already making a big difference. When I reported to the Parliament in June, there were 30 or more instances of single crewing every day in the north and south-west divisions. Such instances have already been reduced to single figures. I have asked the service to provide me with monthly reports on single crewing as it takes forward the action plan, so that I and members of the Scottish Parliament can monitor progress on an on-going basis. I hope that members of all parties will join me in welcoming the fact that routine single crewing of ambulances, which has been an issue of deep concern for many years, particularly in rural Scotland, is being decisively addressed by this Government.
When I gave my statement to the Parliament in June, I made it clear that it was important to reassure members and the public about the service that the Scottish Ambulance Service provides. I hope that the progress that I have set out begins to provide that reassurance. It is evident from the work that has been going on during summer and from the representations that have been made to me directly that the service must continue to work hard to improve communication with its staff, other parts of the health service, MSPs and the public.
Change is inevitable and necessary if we are to provide a modern ambulance service, but change must be managed at the right pace and with the full co-operation of staff and the support and understanding of the public. To address that, during summer the Scottish Ambulance Service reviewed its arrangements for engagement with staff, patients and the wider public and developed a comprehensive communications and engagement plan. In the past few weeks, all MSPs have been invited to meet their local ambulance managers to discuss issues of concern. I hope that all members will take up that opportunity.
I record my sincere thanks to the people who worked so hard during the summer to produce the reports that were made available today, particularly given the challenging timescales that were set for them. I hope that members agree that swift action was taken in May to address the concerns that had been raised about the Scottish Ambulance Service. It is time to move on and to support the service in tackling the challenging agenda of improvement that it faces.
The Government remains committed to ensuring high-quality, safe and effective ambulance services for the whole of Scotland. I am confident that the Scottish Ambulance Service will respond to the challenges that it continues to face and ensure that it delivers that high-quality service for all patients in Scotland.
The cabinet secretary will take questions on the issues that were raised in her statement. We have about 30 minutes for questions, after which we will move to the next item of business—the next item is heavily subscribed, so I have no leeway.
I thank the cabinet secretary for the advance copy of her statement and for the reports. It is clear that she intends to keep me busy in my new role.
I, too, thank everyone who worked hard to produce the reports. I also thank the ambulance crews who have been dealing with a 12 per cent increase in demand for services without additional resources having being made available. It is important to acknowledge the context in which we are working. The Scottish National Party Government has given the national health service its worst financial settlement since devolution and health boards are being asked to make efficiency savings.
The cabinet secretary said that a report on allegations of bullying and harassment in the Scottish Ambulance Service has been completed. Although I understand that it would not be appropriate to comment on individual cases at this stage, allegations of systematic bullying and harassment in any public service are of legitimate public interest. When will the cabinet secretary be able to give details of action that has been taken on the general issues that arise from the report?
Secondly, as the cabinet secretary knows, serious concerns were raised about the ability of single-crewed ambulances to deal effectively with emergency calls—indeed, some of those points led Labour to call for a debate back in May. The additional £4.7 million funding is welcome, but the cabinet secretary indicated that the recruitment of additional front-line staff will take a couple of years and that, at the end of the process, single crewing would be eliminated in all but the most exceptional circumstances. Will she be more specific about what circumstances those would be? Would it be only unforeseen circumstances, or would there be other scenarios in which single crewing would still exist?
I welcome Cathy Jamieson to her new post. I have no doubt that she and I will have our disagreements, but I hope that we can also have some constructive engagement on a range of issues. The issues that we will deal with are important to the people of Scotland, and I know that they expect both of us to treat them accordingly. I wish Cathy Jamieson all the best in her position.
With that piece of consensus over, I move to the substance of Ms Jamieson's questions. On the financial settlement, I must point out that the health budget is now at record levels—we are spending more on health in Scotland than we have ever done in the history of our country. Interestingly, the most recent figures show that, since the Government came to office last May, there have been 5,000 more people employed in our NHS. That does not sound to me like the cuts or backward moves that Cathy Jamieson suggested; it sounds like solid investment in the health of our nation, which is what people expect.
On leadership culture and Ken Corsar's report to the ambulance service, Cathy Jamieson will appreciate why it is not possible for me to go into detail on the issue today. That is fundamentally an employment issue, and it is right that the board of the Scottish Ambulance Service, which instructed the report, can now take it forward. I will not put a specific timescale on when the processes might be concluded, but I assure members that the service is taking forward the issues as quickly as possible and in line with natural justice and due process, which everybody would expect.
Cathy Jamieson said that Labour raised the concerns on single crewing. The first thing that I should point out is that members of the Parliament, such as Mary Scanlon, have been raising the issue of single crewing for an awful lot longer than the Labour Opposition has. Single crewing did not just start when the SNP Government came to power last May. It has been a problem, particularly in rural Scotland, for many years. At last we are getting to grips with the problem, and we are on the way to eliminating rostered single crewing. I hope that all members welcome that.
Exceptional circumstances are, for example, when someone phones in sick at the last minute and cover cannot practically be arranged. Those are the exceptional circumstances that I spoke about, but the important point is that the routine single crewing that has caused so much concern is coming to an end at long last.
I, too, welcome Cathy Jamieson to her new post. As the cabinet secretary said, we will no doubt disagree on many issues, but all politicians from all parties are signed up to the best interests of patients in Scotland and I am sure that we can also agree on many issues.
On behalf of the Scottish Conservatives, I welcome the cabinet secretary's response today. I thank her for the advance copy of her statement and the various accompanying documents, which will take some time to scrutinise.
I am not alone in welcoming the end of single manning. Patients and ambulance staff across the Highlands will strongly welcome the initiative to tackle an issue that I have raised for many years, often filled with the dread that one day I may be alone in the back of an ambulance while the paramedic is driving. None of us would wish for that.
I welcome the fact that there will be a paramedic rather than a technician in the single-crewed fast-response vehicles, but even the most experienced paramedic needs support in some incidents to provide effective treatment and intervention. Will the cabinet secretary put more emphasis on the recording of the effectiveness of the intervention and treatment, as well as on the time that is taken for the vehicle to turn up?
The cabinet secretary announced an additional £4.7 million for the Scottish Ambulance Service over this year and the next two years. Will she clarify whether that is a total of £14.1 million, or of £4.7 million over three years?
As a Highlands and Islands MSP, I ask that at least 20 of the additional 40 front-line staff be allocated to the north division to eliminate single manning.
Following the previous debate on ambulances, I spent a shift with an ambulance crew in Inverness. I met someone with 27 years' service who was being handed his 20 years' service medal, which had been found at the back of a drawer. Will the Scottish Ambulance Service ensure that it values its staff as much as people in Scotland do?
As I sat down after replying to Cathy Jamieson and praising Mary Scanlon for her consistent campaigning on single crewing, Jamie Stone shouted at me that he, too, had raised the issue. Therefore, it is probably appropriate that I record the fact that many members across the Parliament—Jamie Stone and members of my party, such as Rob Gibson, Dave Thompson and Fergus Ewing—have consistently raised the issue. There have also been national newspaper campaigns to highlight single crewing, most recently by the Daily Record. It is to the credit of everybody who has raised the issue that there is now a long-term sustainable solution.
The points that Mary Scanlon made about fast-response vehicles are pertinent. I appreciate that members will not have had time to read in detail the QIS report on the front-loaded model of fast-response vehicle use, but it highlights the issues that Mary Scanlon raises. It states that there is a need for better clinical governance and audit of the outcome of cases in which paramedics treat patients without necessarily conveying them to hospital. The Scottish Ambulance Service is taking that on board. Secondly, in cases in which a paramedic attends in the first instance but considers that conveyance to hospital will be required, there must be certainty for the patient about how long it will take the follow-up ambulance to arrive. The service is working towards ensuring that that will be another 8-minute response time in life-threatening calls. That compares with a 19-minute follow-up target in England, for example. On both those counts, work is well and truly in progress.
On the question about the £4.7 million, while I would like to say that the answer is about £14 million—I cannot do the calculation—over three years, I confirm that, as I hope I made clear in my statement, it is £4.7 million over three years: £1.7 million this year and £1.5 million in each of the next two years.
On staff recruitment, I confirm that the 40 additional staff will be divided 20 and 20 between the north and south-west divisions.
Like the rest of the Scottish population and members in the Parliament, I expect the Scottish Ambulance Service to ensure that its staff are properly valued for the excellent work that they do.
I thank the cabinet secretary for the advance copy of her statement and the accompanying documentation, and for name checking me in what she just said.
My first question concerns the elimination of rostered crewing of fast-response vehicles by technicians, which is to be welcomed. Is there a possibility that the timescale for elimination could be shortened?
The cabinet secretary talked about single crewing being kept to a minimum in the medium term. The Liberal Democrats would like to know when the practice will be eliminated entirely, if she is able to give a date on that.
A letter to the cabinet secretary from Lairg community council, dated 8 September 2008, states that from Monday 1 September to Wednesday 3 September there was no ambulance cover in Lairg due to staffing problems. How could that have been? That was potentially a life-threatening situation within that vast rural area. How does that sit with the statement that she has just given us?
The Scottish Ambulance Service advises me that the rostered crewing of fast-response vehicles by technicians rather than paramedics is an issue only in west-central division and does not happen in other divisions. The service has given a commitment that it will be eliminated by the end of the calendar year, excepting the kind of exceptional circumstances about which I spoke earlier. That is an important commitment.
On the second question, on the instances of single crewing of traditional accident and emergency ambulances, I said in my statement that significant progress has been made towards eliminating that practice. When I stood here previously and spoke about the ambulance service, there were some 30 daily occurrences of single crewing across the two divisions in which it is a problem—that is now down to single figures. By the end of June, the figure averaged four per day, but it was around eight per day in August. That slight increase was due to summer holidays, for example.
I will monitor the instances of single crewing on a monthly basis, and I am happy to share that information with members. We must ensure that we continue the downward pressure towards the elimination of single crewing. The sustainable solution, in terms of the recruitment of staff, will take time to deliver. In the meantime, the Scottish Ambulance Service is committed to continuing extra overtime payments to ensure that the practice is minimised.
On the Lairg issue, which I appreciate is of concern to Jamie Stone—indeed, it is of concern to me—there have been specific recruitment and staffing issues in Lairg, but they are being addressed. I certainly reiterate the importance of their being addressed quickly. One new member of staff has recently been recruited. A part-time relief member of staff was recruited and they have now completed training. They started in post on 8 September. Further recruitment is on-going to get more staff into post. The extra resources that I announced today will allow Lairg to get one additional member of staff over and above the plans that are in place.
We come to open questions. I have 12 members requesting and 18 minutes to fit them into. You do the math, as they say.
I very much welcome the £4.7 million investment in the service for the Highlands and Islands and the south-west. That is one of the best pieces of news of extra spending that we have had in the Parliament. Funding has been a long-standing issue, and I am glad that we are starting to tackle it.
I have questions for the cabinet secretary that follow on from two aspects of previous answers. Will the ambulances that are based in the most remote communities continue to be based there and not be withdrawn to serve the needs of large centres at any time, given the distances involved? Will the recruitment and training cash be used to support the placement of ambulance staff in remote areas, where, for example, housing is an enormous problem? Will the cabinet secretary take that into account in her calculations?
Clearly, the deployment and placement of ambulances and ambulance staff is an operational matter for the Scottish Ambulance Service. I do not suppose anybody in the chamber or, indeed, any member of the public would be particularly reassured if I started to make those decisions for it. However, in general terms, there are no plans, in light of what I have announced today, to relocate ambulances from more rural areas to larger centres as part of the action plan to reduce single manning.
On the second question, it is important that the additional resources are allocated to areas where they are most needed. The key point about the additional staffing resources is that they will increase the relief capacity of the service, which is running considerably below what is considered to be the correct level. The additional resources will address that problem, and I am confident that they will address many of the legitimate issues that Rob Gibson and other members have consistently raised.
I welcome all the reports. On the data issue, does the cabinet secretary agree that, notwithstanding her saying that there was no evidence of deliberate manipulation, there were signs that the service was under pressure? For example, the recategorisation of calls trebled in the three months up to the investigation, but the auto-reporting accounted for 25 per cent of all the improvements, so there was a procedural issue. Can the cabinet secretary clarify that, because it involves a matter of public confidence?
Apart from the welcome £4.7 million, the service is under huge pressure from, for example, single manning, increased general demand and new services such as primary angioplasty. Will the cabinet secretary undertake to review the overall funding in light of the service having to address those issues?
I acknowledge all the pressures that the Scottish Ambulance Service is operating under, but they are not new pressures—the service was under those pressures when the previous Administration was in office. The difference now is that we are making a concerted attempt to help the Scottish Ambulance Service to deal with those pressures.
As I said, the financial settlement for the health service takes health spending in this country to record levels. In my statement, I have committed to provide to the Scottish Ambulance Service, over and above the financial settlement that was announced in the budget, £4.7 million to help it with a particular pressure or problem. That should tell even Richard Simpson that I am a health secretary who is prepared to listen and respond when legitimate issues are raised. I hope that even he can find it within himself to give today's announcement a much warmer welcome.
Let me deal with the specific points that he raised. I covered auto-reporting at scene fully in my statement. Such reporting accounts for 4 percentage points of the 18 per cent performance improvement. It is important to point out that there is nothing wrong with auto-reporting at scene. All ambulance services use auto-reporting at scene, because it is a more accurate way of recording when an ambulance arrives. However, because of the tolerance, a small time lag can exist between the recording of being at scene and actually being at scene. Manual reporting involves a similar problem, in that the person who presses the button in the ambulance might still have 200yd to run to get to the patient. Such problems are not new, but the service wants to refine the system to improve the accuracy of reporting.
On the recategorisation of calls, when members read the data report properly, they will see that there is absolutely no suggestion of inappropriate recategorisation or manipulation. There is a process of management scrutiny of calls, the audit of which the report says could be more robust. The service will address that issue.
I must insist that members ask just one question now or we will not get everyone in.
I welcome the cabinet secretary's announcement on single crews and rapid-response vehicles. Such vehicles undoubtedly make a big difference, but in the present climate they basically determine whether a two-man ambulance turns up. Will that situation continue? If so, will it be monitored? Can we be assured that paramedics, rather than people with lesser qualifications, will be used in rapid-response vehicles?
In many cases where a rapid-response vehicle is sent to an incident, an ambulance will automatically be sent as back-up. I stress that, in any case where a rapid-response unit is crewed by a technician rather than a paramedic, an ambulance will always be deployed automatically as well.
Rapid-response units are a legitimate response to the changing patient need, given that not everyone—not even the majority—who dials 999 for an ambulance needs to be transported to hospital. There have been great advances in the ability of paramedics to offer treatment and to refer patients to places other than hospitals, but they must be developed with the proper transparency and proper public assurance. That is why my announcement today that there will be a further report is appropriate.
Does the cabinet secretary propose to review whether and how the appropriate training and upskilling of ambulance personnel is provided, so that we eliminate any possibility of yet more deaths occurring from an epileptic fit, as happened to my constituent Elaine Fotheringham, whose case was outlined in last weekend's The Mail on Sunday? When a crew of technicians arrived to attend her, they were not allowed to administer the appropriate drugs. How can we avoid yet more deaths, given that that was the second such death this year?
Without going into the details of that case, I assure Helen Eadie that it is the subject of investigation by the Scottish Ambulance Service. The service needs to determine what, if anything—from its point of view—went wrong and what might need to be done by way of response, which is appropriate.
On the general question, the report into the front-loaded model makes it clear that, as the service develops its ways of clinical working, it must ensure that the training and upskilling of its staff is taken forward in parallel. That is one of the central recommendations of the report into the front-loaded model. When Helen Eadie and other members get a chance to read it in full, I hope that they will be reassured.
I refer the cabinet secretary to the final paragraph on page 36 of Professor Donnelly's report, which states:
"There is, at present, no routine validation of data provided in performance reports before they are received by the … Government"
and calls for effective external validation to
"enhance public confidence in the performance reported by the Scottish Ambulance Service and, more broadly, the quality of the service that it provides for patients."
Does the cabinet secretary agree with that, and will validation be brought forward?
I do agree, and it will be brought forward.
Professor Donnelly's report on data makes the point that most performance data that come to the Government are first validated by the information and statistics division. That is not the case with the performance data on response times in the Scottish Ambulance Service. The report was very clear in its recommendation that there should be external validation. The service is currently examining that, and my officials will work with it to ensure that we have a robust form of external validation.
I know that Christine Grahame did not imply this, but, although the report makes that point, there is no suggestion—in fact, such a suggestion was refuted by the group's investigation—that there was anything untoward in any of the data that were passed to the Government
Although I welcome much of the cabinet secretary's statement, I am disappointed that it did not address the shortage of volunteer drivers. How many appointments are missed because of the lack of volunteer drivers? When two appointments are missed, does the patient lose their waiting time guarantee? What is the cost to NHS boards of missed appointments and taxi services when the Scottish Ambulance Service fails?
I agree with Rhoda Grant that volunteer drivers do a wonderful job in the NHS. They provide a very valuable and important service. There is great pressure on that resource, and I am keen to see what we can do to encourage more people to become volunteer drivers, and to ensure that we value those who already do the job. In light of increased energy and fuel costs, one of the key concerns for that group of people is the cost of petrol and the mileage costs that they receive. The service is now reviewing that monthly, which is an improvement on the previous position, where it was reviewed much less frequently. However, I take the point that the volunteer contribution to the service is tremendous and should be valued and encouraged.
This is not exactly on Rhoda Grant's point but, in some of the more rural parts of the country, I have been impressed with the development of first responder schemes, which involve volunteers who are looking to contribute to the sustainability of emergency services in their areas. That is to be commended.
I refer to Cathy Jamieson's question about the cabinet secretary's remarks on the investigation into the leadership culture, about which she is understandably reluctant to say anything substantive. Can I at least tempt the cabinet secretary to confirm that she has been assured and is satisfied that a comprehensive investigation has taken place and that the outcome is likely to be productive as well as speedy?
I am sure that Jackson Carlaw can tempt me in all sorts of directions, but I am not sure that that is one of them.
Steady!
I can feel myself blushing all of a sudden, although not as much as Jackson Carlaw.
In all seriousness, I am restricted in what I can say about this issue. I have not seen Ken Corsar's report, and it would not be appropriate for me to see it at this stage. I have been assured that it is robust and thorough, and that the service is treating it seriously. The service will, as expeditiously as possible, take whatever action it has to take as a result of the report. However, individuals and their jobs are at issue, and it is important that due process is followed.
Three months ago, on 19 June, I suggested to the minister that a practical solution to the problems caused by withdrawing the ambulance service from the Braemar community in my constituency and locating the ambulance 17 miles away in Ballater was to place an additional fast-response vehicle, with a paramedic, in the Braemar community. In response, the minister said:
"I am more than happy to consider any practical suggestion, and I give Mike Rumbles an undertaking that I will do so."—[Official Report, 19 June 2008; c 9982.]
Has she done so?
The Scottish Ambulance Service is actively considering innovative solutions to provide the right kind of cover and sustainable services in rural areas. I gave Mike Rumbles that undertaking. I give him a further undertaking to come back to him with a report on the progress that has been made on the point that he raises and to give him an indication of whether the service considers what he suggests to be a feasible way forward.
Like other members, I welcome the statement, especially the cabinet secretary's comments about tackling the issue of the accuracy of the performance data. The cabinet secretary will be aware of my concerns, which I expressed in response to her statement on 4 June, about the fact that the operational research consultancy targets do not take into account the outcome of an ambulance responding to a category A call—success is measured against a stopwatch rather than according to the success or failure of treating the patient. In the future, will there be scope to consider the outcome for patients in measuring the success of our Scottish Ambulance Service in responding to patients' needs?
I appreciate that point of view, which I know is held by many people, and I have some sympathy for it. I think—and the evidence suggests that the public also think—that, especially in life-threatening cases, speed of response is important, which is why I will always defend the eight-minute target. It is right to expect the service to strive to respond within that time.
However, as I said when Michael Matheson raised the issue previously—I have no hesitation in repeating this today—response time targets are not and should never be the only measurement of the success of the service. The outcome for the patient is critical, and patient outcomes are increasingly what the service looks at. It is no longer the case that the service's only job is to take a patient to hospital. We now have the see-and-treat service, and in many cases the Scottish Ambulance Service is beginning to refer patients to other areas. As I said in response to Mary Scanlon's question, one of the key issues that the report highlights is the need to ensure good clinical governance and audit of the outcomes in all the cases that are dealt with by the service.
What measures will be put in place to ensure that standards of cleanliness are maintained in vehicles? Will the cabinet secretary guarantee that those standards will not be compromised by the funding squeeze that is taking place, whereby settlement increases are being reduced from 6 per cent to 3.15 per cent?
No matter how often Labour members say that there is a funding squeeze, it does not make it true and it does not mean that anybody outside the Parliament will believe them. It would be much more appropriate for members to focus on the issues that are of concern to people. In fairness to James Kelly, he has done that, as he has raised the issue of the cleaning of ambulances, which, like the cleaning of hospitals, is incredibly important.
The service has in place a cleaning and disinfection policy, which forms part of its infection control policy. In addition, it is working to implement the NHS Scotland-wide national cleaning services specification and monitoring framework. It has done some successful trial work on that in Edinburgh and Paisley, and resources have been allocated to roll it out across the two health board areas. That will not be appropriate in every area, but it is important that it is being progressed.
Cleaning is paramount in the Scottish Ambulance Service, as it is in every part of the health service, and it will continue to be monitored. It may interest James Kelly to know that, over the past few months, the infection control team has conducted random vehicle cleaning audits in ambulance stations throughout Scotland, and I expect that to continue.
If the remaining two members are brief and the answers are brief, we will manage to fit them both in.
I welcome the £4.7 million to help to eliminate rostered single crewing. That brings funding into focus—
Straight to the question, please, Mr Doris.
Has any thought been given to using the polluter-pays principle to fund demands on the Scottish Ambulance Service during peak times, for instance on Friday and Saturday nights in town and city centres or when major football games are taking place?
Bob Doris will be aware that, as part of the consultation on alcohol, the Cabinet Secretary for Justice is considering—to use the colloquial term—the polluter-pays principle. That will continue to progress through the consultation. I am pleased to reiterate the fact that the service is receiving record funding from the Scottish Government.
Can the cabinet secretary confirm that the decision earlier this year to merge the north-east and north and west divisions of the service was taken with absolutely no consultation? Does she recognise that the partnership information network guidelines for the NHS say that staff and their representatives should be involved in the design and planning of change, not merely told about it afterwards? Will she now call a halt to the merger process and allow any change to proceed on the basis of full, prior consultation?
That was an operational decision. PIN guidelines are being followed. I suggest to Lewis Macdonald that he should think seriously before spreading undue concern about this issue.
I will explain exactly what the merger of those two divisions will mean—or, more appropriately, what it will not mean. There will be no impact on front-line ambulance staff, no impact on the location of ambulances, no changes to staff numbers in the Aberdeen and Inverness headquarters and no changes to staff locations. The only implication in staffing terms is that there will be one general manager rather than two. The location of the general manager has not yet been determined. This is an operational change for the Scottish Ambulance Service. If it thinks that it will help to deliver a more effective service, it should be supported.
I appeal to members to stick to the facts and not to scaremonger.