Scottish Ambulance Service (Rest Breaks)
The next item of business is a statement by Nicola Sturgeon on Scottish Ambulance Service rest breaks. The Deputy First Minister and Cabinet Secretary for Health, Wellbeing and Cities Strategy will take questions at the end of her statement and, therefore, there should be no interventions or interruptions.
14:33
I am grateful for the opportunity to outline to Parliament the detail of an agreement that has been reached between the management and the staff side of the Scottish Ambulance Service in respect of rest breaks. I believe that the agreement will deliver a long-term and sustainable solution to the management of rest breaks.
I provided Parliament with the background to this long-running issue on 6 October, so I will focus today on what the new partnership agreement delivers for patient safety and for the resilience of the Scottish Ambulance Service.
On 6 October, I detailed the interim arrangements that were to be introduced for a three-month period to ensure patient safety while a longer-term solution was discussed. That three-month period ended on 10 January. During it, affected staff received a pro rata availability payment of £250 per annum and an activation payment of £100 each time they were disturbed during an assigned rest break.
That arrangement was monitored in partnership, and I received the monitoring reports weekly. Over the three-month period, the number of disturbance payments peaked at around 250 per week. During the period of these interim arrangements, negotiations continued and resulted in December in a further offer by management to staff that included a proposed £1,500 buyout of the availability payment and an on-going commitment to a £100 activation payment. Trade unions balloted their members on this offer, but it was rejected by all three trade unions early in January.
Although I was disappointed by the rejection of what I considered to be a fair and reasonable offer, it made it very clear to me that a radically different proposal would be required to reach a resolution of the issue. Ambulance staff had signalled that the issue was not about personal gain and therefore could not be resolved by simply increasing financial offers to individuals. In any event, I was clear that offering higher availability or activation payments would not be acceptable from the public perspective either. It was therefore decided to turn the issue on its head and, instead of seeking a resolution that involved paying existing staff to do more, to explore one that increased the service’s resources and resilience.
Last week, the previous interim arrangements were, with staff side agreement, extended to allow urgent talks on the possibility of such a long-term solution to take place. I am pleased to announce to Parliament today that those talks have reached agreement and that a long-term solution has been found, with new interim arrangements now in place to support its implementation.
The long-term solution is that the Ambulance Service will move towards a 37.5 hour paid working week for relevant staff inclusive of rest periods, with staff required to attend emergency calls throughout their shift period. Let me explain that in more detail. Currently, staff are rostered to be at work for 40 hours per week, are paid for 37.5 hours and are entitled to 2.5 hours of unpaid rest periods. The management of those unpaid rest periods has proved increasingly difficult over time and led to the unacceptable situation where a critically ill person might not be attended to by the nearest available ambulance crew. That situation compromises patient safety and is unfair to staff who, in simply abiding by their contract of employment, can find themselves the subject of public and media anger. That will no longer be the case.
In future, staff will be rostered for 37.5 hours per week and paid for 37.5 hours per week. Their rest breaks will be included in those hours and, although the service remains committed to ensuring that staff are adequately rested, all accident and emergency operational vehicle crew staff, urgent tier staff, air wing staff and special operations response teams will be available to attend emergency calls throughout their entire shift.
This reduction from a 40-hour to a 37.5 hour rostered week, inclusive of meal breaks, obviously reduces the service’s available capacity. As that capacity will have to be replaced, additional investment in the service will be required, just as it would have been to make the payments in the previous offer, had it been accepted. However, resolving the issue in this way ensures that the additional investment will deliver additional staffing, resources and resilience, rather than more money to existing ambulance staff.
In the short term, the Scottish Government will, this financial year, provide the Ambulance Service with additional funding to procure software that will support complex resource and performance modelling to assist in the planning of service change, performance improvement and strategic planning.
In the longer term, the Scottish Government will support the service in employing approximately 150 additional front-line staff to support this fundamental service redesign. These new jobs represent an increased investment in the Ambulance Service of around £5 million per year. The investment will support the further development of critical care paramedics and paramedics with enhanced skills; will strengthen the clinical response to life-threatening emergencies; and offer opportunities to strengthen the service’s resilience and performance. For remote and rural Scotland, this investment will support increased numbers of community paramedics able to work in and with communities as part of an integrated healthcare model, helping to shift the balance of care, and will allow for a review of the geographical deployment of resources to ensure that they are appropriately targeted to meet demand.
Work will begin immediately to support this longer-term solution and both management and staff are committed to moving staff to the 37.5 hour week quickly. However, members will appreciate that such a fundamental change to existing working patterns cannot be achieved for all staff overnight and, in order to safeguard patient safety, new interim arrangements were introduced yesterday.
For the first period of implementation, until the end of June this year, affected staff will be eligible for a payment of £150 per month until they move to the 37.5 hour week, at which point that payment will cease. That new interim arrangement means that all previous availability and activation payments will cease. I can confirm that staff will continue to be required to attend all emergency calls, as allocated, during their shifts.
It is important to stress that both sets of arrangements—the longer-term solution and the new interim arrangements—still require that the Ambulance Service manages rest breaks. The service remains committed to ensuring that staff are rested appropriately. The new arrangements will be monitored in partnership, and I will receive regular reports on progress towards full implementation.
The agreement that has been reached is within the terms of agenda for change, but it recognises the unique position of the Ambulance Service as an emergency service. As I have made clear on a number of occasions, the Scottish Government has never recognised the distinction that some have made that the Ambulance Service is an essential rather than an emergency service. I have always been clear that the Ambulance Service is recognised alongside police and fire services as an emergency service. Indeed, it is subject to the same derogations in the working time regulations as police and fire services. However, the agreement that I have announced puts beyond any doubt the unique nature of the Ambulance Service as an emergency service, while also protecting the benefits that it and its staff derive from agenda for change as part of the wider national health service family. Both those elements will be fundamental to the long-term success of the agreement.
I stress that full implementation of the longer-term agreement will mean that no individual staff member will gain financially when they are required to attend an emergency call during a rest period. I think that that is for the good. The rest period issue has subjected the Ambulance Service and its staff to much public criticism, which has often been unfair, and I therefore welcome a resolution that clearly demonstrates what I have always known and believed to be the case—that the priority of ambulance staff is their patients, not their personal gain.
The agreement that I have outlined allows me to be assured and, more important, it allows me to reassure the public that patient safety is paramount, that the views of the Ambulance Service workforce are respected and that a radical and long-term solution to the issue of the management of rest breaks within the service has been found.
I will be happy to answer any questions that members might have.
We have around 20 minutes for questions, so I would appreciate short questions and short answers so that everyone can get in.
I thank the cabinet secretary for providing an advance copy of her statement, and I join her in welcoming the deal that has been arrived at with the trade unions that represent Ambulance Service employees. I agree that it demonstrates that the priority of ambulance staff is their patients, not their personal gain.
I have received several reports from paramedics that patient safety has been compromised as a result of the interim arrangements. I understand from those front-line staff that red emergency calls have been recategorised as yellow calls. The difference is that a red call is responded to within eight minutes, whereas a yellow call is responded to within 18 minutes. A red call merits a disturbance to the rest break, but a yellow call does not.
However, the distinction in categorisation is driven not—I repeat, not—by a person’s condition but by where they phone. Someone could be having a heart attack. If they dial 999, it will be a red call, but if they call their general practitioner, their health centre or NHS 24, it will be a yellow call. Does the cabinet secretary share my disquiet at that news? Is that practice likely to continue in the future? I am sure that the cabinet secretary will agree that the importance of a call should depend on the severity of the symptoms, not the number that the person calls. Therefore, I ask her, in the interests of patient safety, to instruct an urgent and independent review of that revised system of categorisation.
I thank Jackie Baillie for her welcome for the arrangements that I outlined. I hope that there will be a degree of consensus in the Parliament about the best way forward.
I, too, have heard such allegations or accusations—call them what you want—from ambulance staff, and I have raised them with the Ambulance Service. As I said in my statement in October and repeated today, I have been monitoring the weekly reports on the use of the interim arrangements. Call-outs during rest breaks have, if anything, been slightly higher than anticipated, and the responses that I have had from the Ambulance Service have satisfied me that the arrangements have been used appropriately.
It is important to note that the interim arrangements are no longer in place. The interim arrangements that I announced in October ceased yesterday and are replaced by the new arrangements. I assure Jackie Baillie and the Parliament that I will continue to monitor closely, with the Ambulance Service, the circumstances in which ambulance staff are disturbed during meal breaks, to ensure that the approach is appropriate from the point of view of ambulance staff and appropriate from the point of view of patients and patient safety. Ambulance staff must at all times respond appropriately.
There was a suggestion that the activation payment led to what Jackie Baillie described as misprioritisation. I do not accept that misprioritisation was happening, but the new interim arrangements do not have an activation payment, so any incentive that could have been alleged in that regard no longer exists, if indeed that was happening. Jackie Baillie has my absolute assurance that I will continue to monitor the arrangements carefully.
I am grateful to the cabinet secretary, as ever, for advance sight of her statement.
The benefit of the deal is that it prevents us from ever again having a public debate under the shadow of allegations about the priorities of unions, paramedics or other ambulance crew. Ambulance staff do a great and vital job and we commend them for it. An aspect of meal-break remuneration was that there were questions in the public mind about priorities. Staff priorities are no longer in doubt and high-profile cases such as Tomintoul ought now to belong firmly in the past. I welcome the deal.
Can the cabinet secretary reassure me that the deal is sustainable and that funding is in place throughout? Can she tell me where the funding is coming from and assure me that the new arrangements will not be at the expense of other front-line services? What procedures does she intend to ensure are in place to achieve the required recruitment to the schedule that she set out? I note that an 18-month window is vaguely referred to in the agreement. Is the cabinet secretary satisfied that the approach is robust and that there will be no further financial penalty that she or the taxpayer will have to consider adding to the deal that she has agreed?
I thank Jackson Carlaw for his welcome for the arrangements. The deal that I have announced is fair and sustainable and recognises patient safety concerns and the concerns of ambulance staff. It ensures that staff are adequately rewarded for the job that they do, while also being rested appropriately. For all those reasons, I expect the deal to stick.
I announced that funding will be made available in this financial year to the Ambulance Service, for software to allow it to do the work that is needed to reorganise shifts. The funding will be in the region of half a million pounds. There will be a cost associated with the new, time-limited interim arrangements, and the long-term, on-going cost of the deal will be £5 million per year, as I said. That money will be additional to the Ambulance Service’s current allocation.
A couple of years ago, I announced additional funding for the Ambulance Service to recruit extra staff to deal with the problem of single crewing, particularly in the north and south of Scotland. The Ambulance Service has recent experience of recruiting people to deal with a particular problem.
I would not like it to be lost from our discussion that I am announcing 150 new jobs in the Ambulance Service. That is fundamentally and first and foremost to fulfil a requirement as a result of the deal that I have announced, but I am sure that all members acknowledge that, in the current economic climate, such a commitment to extra jobs is extremely welcome. I would not expect the Ambulance Service to have difficulty recruiting new staff. The service will of course then have the obligation to train its new staff and get them ready for work.
I welcome the resolution to the matter. However, given that a previous agreement foundered on a ballot of the trade unions, will the cabinet secretary clarify what the situation is in relation to the current agreement and a potential trade union ballot?
In the final analysis, it is up to trade unions to decide on their arrangements with their members, but the agreement that I have announced today, which delivers a 37.5 hour working week, is within the framework of the agenda for change, which is predicated on a 37.5 hour working week. The trade unions have signed the agreement on the basis that, for those reasons, it does not require to go out to a ballot of their wider membership.
Further to Jackie Baillie’s question, will the cabinet secretary now terminate the yellow category response—or ensure that it is terminated—as it is causing confusion?
Can the cabinet secretary confirm that ambulance workers are now categorised as emergency workers under the EU working time directive, in the same way as firefighters and police officers are? Is that a change?
Further to Jackson Carlaw’s question, will the cabinet secretary provide written details on the new £5 million? I calculate that there has been a loss of capacity of about 5 or 5.5 per cent in a budget of £200 million and I am not clear how the £5 million will replace that capacity. I understand that it will take some time to build up new capacity.
The Ambulance Service has always been subject to the same derogations from the working time regulations as the police and fire services are, so the agreement is not a change. I have always said that I did not recognise, politically, that the Ambulance Service was less of an emergency service than the police and fire services, and that there was no legal basis for saying that. However, the new arrangement that I have announced today underlines that and puts the matter beyond any doubt. For that reason, I hope that it will be welcomed.
It is for the Ambulance Service to determine in its emergency medical dispatch centres the appropriate categorisation of calls and to respond appropriately. I am more than happy to reflect on Jackie Baillie’s points but, as I understand it, at the centre of what she said was a suggestion, which I refuted, that because an ambulance worker had to be paid £100 to be disturbed during a rest break, calls had been downgraded to avoid that activation. Even if there had at any time been a suggestion that that was happening, the activation system no longer exists. Under the interim arrangements that are now in place, staff will be paid a flat £150 per month whether they are called out 10 times during a month or not at all. I do not accept the basis of Jackie Baillie’s question, but if it ever had any basis, that has now been removed. However, I will reflect further on the detail of the points that have been made.
Before I forget, I will mention the £5 million. I am more than happy to write to members with more details on how the Ambulance Service will make up the lost capacity. As Richard Simpson will appreciate, it will substantially be made up through the additional staff, but there will also be differences and efficiencies in how the Ambulance Service rosters shifts, which will help to make up some of the lost capacity. However, the commitment to provide £5 million and 150 new members of staff is substantial and I hope that all members will welcome it.
I, too, warmly welcome the announcement, particularly in light of the fact that I live near the Gray family, who suffered a tragic bereavement last year. I listened with interest to the point that 150 new jobs will be created, which is a substantial achievement in difficult economic circumstances. Will the cabinet secretary clarify her thinking on the expected lead-in time before those new people are in position?
Before I go into the detail of Annabelle Ewing’s question, I think that it is important to reflect on the fact that the controversy and discussion arose out of two tragic cases. I am sure that, today, we will all want to remember those cases and the grief that has resulted to the families involved. My officials have attempted to keep both families as up to date as possible with progress on the discussions. I hope that both families will take some comfort from the fact that we have a long-term resolution of the issue.
On the detailed question on the lead-in time, I would hope and expect—this is reflected in the new interim arrangements—that the shift to a new 37.5 hour working week will be accomplished substantially within the five-month period that the new interim arrangements cover. There will continue to be discussions and, if any part of the implementation is not completed by the end of that period, we will discuss arrangements to cover any time remaining before full implementation.
I emphasise again that there will be 150 new jobs for new recruits to the Ambulance Service. Despite all the controversy, most of the people to whom I speak in the Ambulance Service say that it is a great job to do—that it is a difficult, challenging job but one that is extremely rewarding. I hope that 150 people take the opportunity over the next few months to become part of what is a fantastic service.
I thank the cabinet secretary for advance sight of her statement and I warmly welcome the resolution and the deal that she set out. In the context of the commitment to end single manning, what effect will the additional resources that she has announced today have on meeting and delivering on that commitment and how will that be monitored? In her statement, she also referred to the needs of remote and rural Scotland and a review of the geographical deployment of resources. I know that she will not need to be reminded by me of the specific circumstances that face emergency crews in island areas and of how they will be reflected in the review.
Understandably, Liam McArthur raises the issue from the perspective of island communities. I think that the additional resources will be particularly welcome in remote and rural parts of Scotland because they will give additional resilience to the Ambulance Service and more flexibility in dealing with some of the issues that they grapple with on a day-to-day basis.
On single crewing, the investment that I have announced today is not designed to eliminate single crewing, which has been substantially eliminated from the Ambulance Service. Members will recall that, back in 2008, I announced that just under £5 million over three years would be used to recruit 40 additional staff—20 in the north and 20 in the south-west. Those staff have been recruited and single crewing has, as of late 2010, effectively been eliminated. The Ambulance Service in the Highlands has faced some recent challenges where there have been occurrences of single crewing, but the service is taking action to deal with that and I am receiving quarterly reports on the situation. Thankfully, single crewing is no longer routine in the Ambulance Service and we will continue to do what needs to be done to ensure that, except in the most exceptional circumstances, it is eliminated.
I, too, thank the cabinet secretary for her statement. Increasing the resources sounds like the right kind of solution, especially to those of us in rural areas, where ambulances are necessarily thinner on the ground. However, I make the point that rests are necessary for anybody doing a serious job, especially if they are driving. Can the cabinet secretary give me an idea of how rests will be achieved for ambulance crews and how we will be sure that they get them without compromising the availability of ambulances in rural areas?
I thank Nigel Don for what is a fundamental question. It gives me the opportunity to place on record my thanks to the Ambulance Service. It has been distressing to me over the past few weeks and months to be in dispute with a service that I rate so highly. Those in the Ambulance Service do a fantastic job individually and collectively and they deserve the thanks of all of us. It is important because of the difficulty of the job that they do that they are adequately rested during shifts. The Ambulance Service will continue to schedule rest breaks within the shift pattern and endeavour to ensure that the staff get those rest breaks on an uninterrupted basis.
The difference between the new arrangements and the previous ones that we were trying to fix is that the ambulance crews will be on call for emergency cases during the rest breaks. If somebody has an emergency and needs an ambulance, the nearest ambulance will attend, regardless of whether the crew members are on a rest break. As part of the new working week, in return for being on call during their rest breaks, the staff will be at work two and a half hours less a week than they are at the moment. To make that up, there will be 150 new jobs—all in all, a good deal.
I have raised with the cabinet secretary on numerous occasions the lack of service provided by the Ambulance Service in rural areas. Indeed, it is often the case that the ambulance is over an hour away from the community that it seeks to serve. The cabinet secretary advised in her statement that there will be an increased number of community paramedics for rural areas. Can she give details of the status of those paramedics? Will they be full-time employees with access to emergency vehicles? Can she also tell us what rural areas will benefit from those new posts?
I have announced that there will be approximately 150 whole-time equivalent, new members of the Ambulance Service. I am sure that the member will appreciate that how they are deployed, how many are full-time, how many are part-time and what parts of the country they are deployed in are operational matters for the Ambulance Service. As those plans are implemented, I will be more than happy to keep members updated about the exact deployment of those additional resources. I know that members will have particular interest from their local and constituency perspectives.
In her statement, the cabinet secretary said that the investment will support the further development of critical care paramedics and paramedics with enhanced skills. Can she expand on that, with particular reference to rural areas?
First, the additional staff members whom I have announced today will replace the capacity that will be lost to the Ambulance Service as a result of reducing the number of hours for which the existing staff will be at work. However, the additional resource will enable the service to do more of what it is already doing and consider the ways in which paramedics work in an increasingly integrated way with other members of the health team. The service is a crucial part of the national health service, but it increasingly works closely with territorial health boards and other health services. Paramedics no longer simply convey people to hospital; they often treat people at the scene. The additional resource will give the service more capacity to develop that kind of role as well as plugging the gap that will arise because of the deal that I have announced today.
All in all, this is really positive for the Ambulance Service. As I said to Rhoda Grant, I am more than happy to keep members updated as the deal is implemented.
The cabinet secretary referred to 150 new members of the Ambulance Service. Will she confirm that those are in addition to the existing 86 vacancies and detail how many of those posts will be paramedic posts? The cabinet secretary will be aware that it takes up to two years to train a paramedic. How will she deal with increased demand in the short term, considering that overtime budgets have been halved?
Yes, they will be additional members of staff. It is for the Ambulance Service to determine exactly what the make-up of that new cohort of 150 members of staff will be, and that decision will be driven by service needs.
With regard to the interim period, I said openly in my statement that this solution cannot be implemented overnight, as it takes time to recruit and train Ambulance Service staff, which is why we have in place an interim arrangement that will pay ambulance staff £150 a month over their salary and any other overtime payments that they have.
This is a good deal that provides a good resolution to a difficult and long-running dispute. I know that a lot of issues of detail exist and that members will want to be kept up to date as the arrangement is implemented. I have given an undertaking to do that. However, we should all get behind this deal and get behind the Ambulance Service as it implements it.
Can the cabinet secretary give further details on the current compliance with the targets for category A and B calls?
The 2010-11 figures show that the full-year performance for category A was 72 per cent, which is slightly down on the previous year, but up from 62 per cent in 2007-08, and the full-year performance for category B was 92.6 per cent, which is up from 91.4 per cent for 2007-08. On response times generally, the Ambulance Service has improved dramatically in recent years, but it still has a way to go to meet its targets. As well as all of the other reasons for the new resources, they will also help the service to ensure that it is meeting all its targets and continuing to provide a quality service.