Scottish Ambulance Service
The next item of business is a debate on motion S3M-1955, in the name of Margaret Curran, on the Scottish Ambulance Service.
I am pleased to open this debate, because of the importance of the Scottish Ambulance Service to Scotland and the need to scrutinise recent changes, which could have—and are having—a significant impact on such an important public service.
I am sure that all members will join me in paying tribute to and thanking ambulance staff throughout Scotland for the vital work that they do. The Labour Party has brought this debate to the Parliament because ambulance staff have such high standing and because of the issues that they have drawn to our attention.
Labour believes that changes that alter crucially the nature of the service should be open to consultation and should be communicated properly to the people of Scotland. At the very least, people should understand the changes and know what to expect from this key public service.
In the short time available to me, I will flag up key questions that must be asked and key issues that must be addressed. The ambulance service is so important that it deserves treatment equal to that of any other service within the national health service. I am sure that many members have received representation about the issues that I will flag up. It is vital that the Parliament addresses those issues and takes them seriously.
I am not arguing against change. All services require to be modernised and changes must be introduced, but we must question how they are introduced. We should pay tribute to the Scottish Ambulance Service, which has embraced change many times effectively and efficiently. Indeed, it has a great track record in industrial relations.
Agreeing the Labour motion would establish fundamental issues. It would require the Scottish Ambulance Service to explain why and how changes have been introduced and what the consequences of those changes are. The service should explain that not just to the minister or the health directorate, but to the Parliament and, more important, to the people of Scotland.
Serious questions are being asked about what the changes to the service are, why they have been introduced and the impact that they are having. For example, has there been a study of the impact on patient safety of the replacement of double-crewed ambulances with single-crewed rapid response vehicles? Has there been any evaluation of the clinical risks involved in that and of when single-crewed vehicles are to be dispatched?
I welcome the member's comments so far. Is she aware that the model has not only been evaluated positively south of the border, but is subject to an on-going external evaluation in Lanarkshire?
I am grateful for that information from the minister. I am sure that in her contribution she will take us through that. However, I am also sure that she will agree that if the evidence was so strong, it is deeply concerning that we are receiving so many representations, that the public does not know anything about the changes and that there are still so many fundamental questions being asked. I hope that she will reflect that perhaps the processes that have been introduced have not been adequate to meet that public challenge.
Perhaps she will tell us about the health and safety risks to single-crew responders. Has there been consultation with trade unions in Scotland? Has there been consultation with communities where double-crewed ambulances are being replaced by single-crewed rapid response vehicles? Those are points of substantial concern. I believe that the changes should be subject to external evaluation.
The Parliament must address a few other issues. Given the minister's knowledge of the subject, I hope that she can address the issues directly. I am told that vacant shifts are currently not being covered because of budgetary restrictions. I see the minister shaking her head, so I hope that she can clarify the situation. I am told that there are as many as 25 shifts per day short in Glasgow city alone. I am told that, because staff are under pressure, ambulances are not being cleaned properly, which could give rise to infection, and that we have the prospect of industrial unrest. Those are serious issues, which I hope can be addressed. That is why we have brought the debate.
That is just a snapshot of some of the concerns that have been raised throughout Scotland. I know that other members will talk about the situation in rural areas in particular, as well as the situation that I have described in Glasgow, about which I am concerned.
The SNP should be consistent in its approach to handling issues in the national health service. If public consultation on service changes within the NHS is important in one dimension, it should be important in others. The SNP should not be opportunistic about that.
Labour would be open-minded about the shape of the independent scrutiny of any changes to the ambulance service, but our key point is that there must be an independent element. We have brought the debate to the chamber because it seems that, until now, the Government has not properly overseen the changes that are raising such fundamental questions or properly responded to those questions. The SNP's amendment is disappointing and unacceptable. It is not for the Parliament to direct a committee inquiry and the Government should not tell committees what to do. Such an inquiry should not be a means by which the Government can duck its responsibility and once again pass the buck.
I will say a few words about the Liberal Democrat amendment. It certainly improves the Government's amendment, but there are some caveats and I seek clarification from the Liberal Democrats. The Parliament needs to act and be seen to act in a way that reflects the scale of the problem and the depth of the concern that is being articulated throughout Scotland. Motivated by those concerns, many people have asked for an independent objective analysis to be introduced to the process and I hope that that is part of the Liberal Democrats' argument today.
There is one more element of the Liberal Democrat amendment that concerns me. It needs to be appreciated that many members question the validity of some of the progress that has been made, particularly on response times. They argue that response-time targets have not been properly met. That is why we have brought the debate to the chamber. Members have been asked to question what has been done to the ambulance service and how the response-time figures have been produced, and that is why we need an independent assessment. The assumption that the progress that has been made is not to be questioned weakens the Liberal Democrat amendment.
If we were to support the Liberal Democrat amendment, which calls for a full statement, and the amendment were agreed to, could we get any guarantees on that? Could we have the statement before the summer recess? Could we have the statement with a debate? I ask that the work that is undertaken to prepare for that statement will not be just an internal discussion between the minister, the department and the Scottish Ambulance Service; but that it will be broad based, and will engage with the staff of the ambulance service and with other concerns throughout Scotland.
It is vital that we widen the discussion. The ambulance service and the public in Scotland expect a proper and thorough approach to these issues. Labour is deeply committed to this valuable service and we must continue to listen to the ambulance service staff and the public, who are deeply concerned. We will pursue these issues and I look forward to hearing members' contributions as we determine the proper resolution of this great challenge that we face.
I move,
That the Parliament recognises the concerns expressed by the Scottish public about recent changes to the operation of the Scottish Ambulance Service; believes that, as the ambulance service is a widely respected and essential public service in Scotland, any changes should have been communicated to the Scottish public, and, in light of concerns expressed about the safety of patients, agrees that there should be immediate independent scrutiny of current practices and policies in the Scottish Ambulance Service.
I welcome the debate. I take very seriously any concerns that are expressed about the performance of any NHS board and I understand very well the importance of public confidence in the Scottish Ambulance Service. I indicated in the chamber as recently as last week my concern, for example, about the single manning of ambulances that should be double crewed. The Scottish Ambulance Service is now under an obligation to report to me regularly on the incidence of single manning and the actions that it is taking to reduce it. I will in turn keep Parliament updated.
If Margaret Curran has any evidence of the other serious issues that she has raised today, I assure her that I will treat that equally seriously. However, it is important to be clear that many of the developments that Margaret Curran mentioned are about improving response times and the overall patient experience of the ambulance service.
Will the member take an intervention on that point?
I am spoiled for choice—I will take Duncan McNeil's intervention.
In the Inverclyde area, we are well served by the ambulance service, and we congratulate it on the job that it does. We currently have an 80 per cent response rate to category A calls. Does the Cabinet Secretary for Health and Wellbeing recognise that there are real concerns about the target of 75 per cent for those calls for 2009 and does she understand that we cannot allow that to have a detrimental impact? The ambulance service in my area already does better than the target for 2009 and we want to maintain the high standard in relation to response times. Will she accept that the changes might impact on the good service that we have by stretching it geographically, which would have a detrimental impact in taking us back to a 75 per cent response rate?
I appreciate the member's point but, on the contrary, some of the changes are actually responsible for that improvement in performance. I take the opportunity to pay tribute, as Margaret Curran did, to the work of ambulance staff in helping to bring about the improvements that have been achieved in recent months. In March 2007, the ambulance service was reaching only 56 per cent of category A calls within the target time of eight minutes and that was a serious concern. In April this year, that performance had improved to 73 per cent across the country. Those figures are subject to rigorous monitoring and I ask Margaret Curran again, if she has evidence to suggest that they are not accurate, to submit it to me in writing.
The point that the cabinet secretary made about the response rate rising from 55 per cent to 73 per cent is the crux of the problem. How many of the responses in that 73 per cent were made by single-manned or rapid response vehicles, as opposed to the previous figure of 55 per cent, of which the overwhelming majority were double-manned and therefore able to treat the patient immediately, on the spot?
I am coming to that, so the member's intervention is timeous. There is no doubt that the improvement is linked to the decision that was taken last November to expand—I stress the word expand and I will come back to it later—the existing front-loaded model, that would result in additional rapid response units attending incidents, requesting assistance when required, and increasing see-and-treat rates over time. That approach is intended to improve response times, which are of the utmost importance to patients in reducing unnecessary patient journeys and improving overall experience. It will also lead to a net increase in the number of emergency vehicles in the ambulance service fleet. The front-loaded model, which, as I said earlier, has already been subject to positive evaluation in England, is currently being externally and independently evaluated in Lanarkshire.
I was more than a bit surprised to hear Labour call for independent scrutiny—a process that I have made clear will apply to cases of major service change. The reason for that surprise is that the model that we are talking about is not new to the ambulance service in Scotland. The use of rapid response vehicles as a critical element of the front-line ambulance fleet was first—
I must make some progress. It was first introduced in Scotland in 2002, by the then Labour Administration. That Administration also recognised that not all patients who are seen and treated by paramedics need to be taken to hospital. The principle of see and treat was adopted at that stage.
At the annual review of the Scottish Ambulance Service last year, I discussed with the board how it had achieved a nearly 9 per cent see-and-treat rate in the last year of the previous Administration, and how and to what level it planned to increase that. All of that was discussed in public and recorded in my follow-up letter to the board chair in October last year. I do not accept that the expanded use of an operational model that was first introduced into the ambulance service in 2002 can be construed as a major change that would justify independent scrutiny. However, I accept—and I hope that we can reach some consensus—that as the Scottish Ambulance Service continues to develop its operational practices, it must properly engage with its staff and with the public that it serves.
I am in my last minute. The NHS has a staff governance standard to be proud of and partnership working is at the heart of my view of the NHS as a mutual organisation. I therefore expect the board to engage fully and properly with its staff and I will treat very seriously any suggestion that it is not doing so. Likewise, the public must be properly informed of any operational changes that will impact on them.
As I indicated earlier, those issues were discussed fully at last year's annual review of the Scottish Ambulance Service. They were also discussed in greater detail and approved by the board at its meeting in November last year, again in public session. At a local level, ambulance service managers have been engaging with local communities to explain the proposed developments and what they will mean for patient care.
However, if there is concern about these developments, the service must increase its efforts in that regard and I will ensure that it does so. I recently spent a Friday night with a rapid response paramedic in Glasgow to see for myself how that model works and I know that the ambulance service would be happy to afford that opportunity to any MSP who wishes to take it up.
Public confidence in the ambulance service is high, but there is no room for complacency. That is why my amendment, although it acknowledges completely the autonomy of the Health and Sport Committee, makes it clear that I would welcome the committee examining those matters.
I can also confirm that, if it is the will of the Parliament, I am more than happy to make a statement at the earliest opportunity that sets out in more detail the work that the Scottish Ambulance Service is doing to improve the service that it provides to patients, although Margaret Curran will appreciate that the timing of such a statement is not in my gift. I am proud of the work that the Scottish Ambulance Service undertakes on behalf of the Scottish public but, as the Cabinet Secretary for Health and Wellbeing, I am determined to ensure that that work continues to improve in the interests of patients.
I move amendment S3M-1955.1, to leave out from "recognises" to end and insert:
"welcomes the improved performance demonstrated by the Scottish Ambulance Service in recent months, particularly in relation to responding more quickly to life threatening calls; congratulates the staff of the Scottish Ambulance Service for their efforts in achieving this improvement for patients; acknowledges the need to ensure that the Scottish Ambulance Service continues to improve across a range of indicators and that it effectively consults staff and communicates with the public about the service it provides for them, and, while recognising its autonomy, would welcome the Health and Sport Committee undertaking a review of these matters."
Notwithstanding the excellence of much that the Scottish Ambulance Service does, a person would have to be very deaf not to know that there are serious public misgivings about certain aspects of the service that it provides. Margaret Curran said that members have received letters on the matter. We have received e-mails and representations from Scottish Ambulance Service workers and trade union representatives that express concerns about aspects of service delivery and staff morale. The Labour Party was right to lodge a motion to highlight such concerns.
I agree with Margaret Curran's opening sentiment and the first part of the cabinet secretary's amendment in particular. I, too, praise Scottish Ambulance Service staff for their dedication and professionalism, but we have concerns about the management of the service and more particularly about the Government, which is ultimately responsible for the service. It is understandable that the cabinet secretary should want to defend the Scottish Ambulance Service's overall record, but her speech was slightly defensive with respect to the concerns that many members will articulate in the debate. I welcome the offer that she made in her closing remarks: she said that she would be prepared to give a full description in the chamber of what the Scottish Ambulance Service is doing. I hope that she will also address the points that members, including me, will make in the debate.
It is important that the Parliament establishes the principle of parliamentary scrutiny. The Parliament should hold ministers to account. I am therefore a little disappointed that the Labour Party should try to shuffle scrutiny to some other body in the first instance.
I make it clear that it is not an either/or issue. An independent process is not a substitute for parliamentary scrutiny—in that sense, I welcome Ross Finnie's amendment. However, it is vital that there is not simply a traditional ministerial statement that gives a lengthier version of what we have already heard. There should be evaluation and objective analysis of what is happening in the Scottish Ambulance Service, not simply a defence of the existing process.
In calling for a statement after a debate, we are calling for the Parliament to hold the cabinet secretary to account. It would be enormously disappointing if the cabinet secretary did not reflect on every single issue that is raised in this debate, although I am sure that she will do so. It is an important principle that the Parliament should scrutinise. Let us cut to the chase and agree a motion that calls on the minister to make a statement.
Serious concerns exist. The cabinet secretary has said that single-person crews have been evaluated. If they have been so well evaluated, why has the British Medical Association passed a resolution that first-line ambulances should be double crewed in all but extreme circumstances? Why has the chief executive of the Scottish Patients Association, Dr Jean Turner, said:
"If a two-strong team is needed during the day it should be exactly the same at night"?
If we are going to have rapid responses, she is right. There have been such responses for some time, but the prime test is not the time that is taken to respond—it is what happens to the patient. If 25 per cent of shifts in Glasgow are not being dealt with, there is a problem.
Having response-time targets is fine, but Duncan McNeil made a valid point. If we are setting standards that lower the bar or keep it at the same height instead of raising it, that is not fine.
Finally, the cabinet secretary must address at some stage Dr Walker's report on the hospital service at Ayr. He seriously questioned the evidence that supports longer ambulance response times. The Parliament deserves an answer to what he said.
I have pleasure in moving amendment S3M-1955.1.1, to leave out from "while recognising" to end and insert:
"calls on the Cabinet Secretary for Health and Wellbeing to make a full statement to the Parliament, at the earliest opportunity, on the operation of the Scottish Ambulance Service, specifically the use of single person crews, the deployment of rapid response vehicles, ambulance response times, rates of assaults on ambulance crews and the impact of journey length on patient safety."
I thank and commend the Labour Party for choosing to debate the Scottish Ambulance Service and fully support Margaret Curran's call for a full debate. I also join members in praising the excellent work that the Scottish Ambulance Service does.
The key starting point for the debate is the 12 per cent increase in demand for the ambulance service year on year, which Audit Scotland has confirmed. That increase is the result of NHS 24 referrals and more people using the service out of hours to access health care. One would expect an increase in supply to match such increased demand, but it appears that the opposite is the case; it appears that demand has increased and supply has decreased.
The cabinet secretary will know that in the Highlands—particularly in Sutherland—there is regular single manning of vehicles in response to category A calls. A local member of staff in the ambulance service in the Highlands recently offered to do some overtime work, but he was told that such work could be done only at red stations. That was the first time that he and his colleagues had heard about the new coding of red, amber and green stations for manning. So much for ambulance management communications. Staff did not even know about that.
Problems with the ambulance service are not confined to the Highlands. My colleague John Scott has made me aware of serious concerns in the NHS Ayrshire and Arran area. I have been led to believe that between 40 and 70 ambulances in Scotland are being taken off the road to be replaced by what is known as a front-loading model—I think that that means that a single paramedic will respond to an incident, and will see and treat at the scene, which should mean that there will be fewer admissions to hospitals. I commend the work that paramedics do, but it is surely unfair to expect them to have the diagnostic and treatment skills of a general practitioner who has taken nine years to train for their profession.
Last week, NHS Highland briefed MSPs on treatments for the two types of stroke. We were told that there is an optimum time within which thrombolysis must be given and also that the diagnosis and treatment of strokes can be made only on the basis of a clinician's judgment—I understand that strokes are not easy to diagnose. That example illustrates the fact that single manning, seeing and treating at the scene and aiming for fewer admissions to hospitals are not appropriate in all emergency call-outs.
In the recent Scottish Ambulance Service annual review, the cabinet secretary stated:
"For those cases which required thrombolysis, the average … time was 43 minutes",
which is well below the 90 minutes optimum time. How many patients who would have benefited from that intervention did not reach the hospital in time, did not meet a stroke physician for diagnosis or were deemed not unwell enough to be taken to hospital? The Scottish health council's annual report concluded that "little or no progress" had been made by the service in evaluating patient focus and public involvement activity.
I have much to say, but little time in which to say it; I will therefore move on to the final points that I want to make.
Audit Scotland reported that the Scottish Ambulance Service had missed its performance targets. I listened carefully to the cabinet secretary, but did not hear much about the service's improved performance in recent months.
We like the Labour Party's motion and again thank it for this debate. However, we are unsure about immediate independent scrutiny and whether that was proposed on the basis that there should be a major service change.
On the Government's amendment, ministers should not tell the Health and Sport Committee what to do. However, we like the bit in the middle.
We support and fully agree with the Liberals' amendment.
I, too, welcome the opportunity to speak in the debate and pay tribute to those who work in the Scottish Ambulance Service.
The issue of single-crewed ambulances was first raised with me by a constituent who was concerned about an incident in which a back-up crew took a considerable time to arrive. The cabinet secretary knows the geography of Ayrshire, so she will know that bringing an ambulance up from Stranraer to Girvan is not the easiest thing to do. My constituent was concerned not about the service that was received from the paramedics who arrived on the scene; rather, he thought that there could have been a problem if the incident had been more serious.
I am not opposed to change that will benefit patients, so I approached discussions about that incident and associated issues with the Ambulance Service with an open mind. However, I then discovered that concerns had been raised by many other constituents, including those that were raised at a recent public meeting in Maybole about the proposal to introduce a rapid response vehicle to replace a double-crewed ambulance. Some of the issues that were raised concerned the pressures of the eight-minute target time in rural areas and whether, instead of aiding patient care, the insistence on meeting that target time means that the wrong type of vehicle turns up to deal with people.
Concern was also raised at the meeting in Maybole about the lack of local knowledge among those who had made the decisions about where back-up ambulances would come from. Indeed, it was suggested that, if a local back-up ambulance was not available in Girvan, one could come from Cumnock. The cabinet secretary will be aware of the distance from Cumnock to Maybole over the A70, which most of us will know has a number of serious accident black spots.
Unfortunately, the airing of some of those concerns coincided with the publication of an article in The Herald on 8 May that stated that patients who require angioplasty will go straight to Hairmyres hospital in East Kilbride, bypassing both Ayr and Crosshouse hospitals. Members will understand that people were concerned about the implications of a potential 65-mile journey from Ballantrae, in the south of my constituency, to East Kilbride. I hope that the minister will clarify the position today. Will all heart attack patients now go to East Kilbride, or will they go to Ayr or Crosshouse and then be transferred? Who will make the decision if some of them are to go straight to East Kilbride? I hope that the minister will recognise that it is not scaremongering—as one of her colleagues has suggested locally—for me to raise those questions. I do that on behalf of my constituents, who want to know the answers.
I make no criticism of the ambulance staff who came to the meeting at Maybole. They gave a good account of themselves and treated the public with the respect that they deserve. Nevertheless, I am concerned by a number of other issues that have been raised by the trade unions, such as ambulance staff not having enough time to clean ambulances. I do not know whether that is true—perhaps the minister can deal with that in her summing up. It has also been suggested to me that the definition of the eight-minute arrival time has been changed and that it no longer refers to arrival at the scene but refers to arrival within 200yd, as decided by the global positioning system.
Another issue that has been raised with me, which is serious and must be taken into account, is that there now appears to be a culture of bullying and harassment in the Ambulance Service. People have approached me in confidence and have raised their concerns about that through the trade union. They feel that the whole service will be put at risk if the matter is not addressed.
I hope that the cabinet secretary will take my comments in the spirit in which they are intended. It is a matter of patient care. People in rural areas need to know that they will get the service that is required, not one that is secondary to the one that is delivered in other parts of the country. I hope that she will be able to respond to my remarks.
I preface my remarks with the observation that we are very proud of those who work in the Scottish Ambulance Service and very grateful for their services. Nothing that follows is intended to be any criticism of them.
I will pick up on an issue that has not yet been highlighted, relating to the situation in which there is a long and winding road from the hospital to a patient's place of residence. I am referring to the Dee valley, which runs from the south of Aberdeen westwards into the Grampians. On the way, the road passes through Banchory, Aboyne, Ballater and, eventually, Braemar. The distance from each place to the next is roughly 15 miles, so the total distance between Aberdeen and Braemar is roughly 60 miles.
Once upon a time, there was an ambulance in Braemar. There is still a fire station there. Recently, the ambulance was moved to Aboyne, which is 30 miles nearer to Aberdeen, and it is now a 24-hour single-manned rapid response vehicle. I am pretty sure that the Ambulance Service managers who decided to move the ambulance to Aboyne applied their model correctly. I am not accusing anybody of incompetence, carelessness or indifference to the needs of the patients. I suspect that they applied the model perfectly correctly and came up with what they thought was the right answer. However, Braemar is now not just 60 miles from the hospital but 30 miles from the ambulance. That means that an arrival time of seven minutes is simply inconceivable; in fact, if the ambulance has to come from Aboyne to Braemar to take a patient to Aberdeen, the golden hour will already have passed before the ambulance goes back past the ambulance station.
My concern is not that those who have designed the service have got their thinking and calculations wrong but that they are working with the wrong model in that particular circumstance. In Braemar, there is a fire station and, in or very close to Braemar, there are folk who know how to drive big vehicles with blue flashing lights. There is also a doctor in Braemar and there are other folk who know how to attend medical emergencies—there is a mountain rescue team in the area. Therefore, I suggest that the cabinet secretary ask the Ambulance Service and her officials to consider an alternative model, which would allow the stationing of a vehicle in Braemar that could be crewed by a fireman and sent to wherever the patient was. It could meet somebody else who had the appropriate medical qualifications and who could be otherwise mobilised.
Such a model could hugely improve the response time at the Braemar end of the valley. It would not involve a huge cost, although I acknowledge that it might involve having one vehicle more. I am conscious that the fire and rescue service is not within the cabinet secretary's portfolio but, nevertheless, my plea to her is that she get the two services to talk to each other and consider whether alternative models could be used in places where the road runs out at the head of the valley or at the sea. I ask her to consider whether alternative models could be used to improve the ambulance service in such areas.
It is clear from the debate that the Scottish public have genuine concerns about recent changes to the operation of the Scottish Ambulance Service. I believe that those changes deserve immediate independent examination. The replacement of two-person crews with one-person emergency rapid response units deserves serious scrutiny. The public tell us that that is not safe and that it is causing them concern. The people on the ground who are delivering the service directly to the public—the ambulance crews—tell us that it is not working and that it is not allowing them to do the job to the standard to which they wish to do it.
However, the non-emergency service that is provided by the Ambulance Service is also critical to patients throughout Scotland. Every year, hundreds of thousands of patient journeys are made, as people are transported between hospitals, clinics, day centres and their homes. The experience of one my constituents highlights serious questions about the Ambulance Service's practice and policy for non-emergency transport as well.
Catherine Young, who is a constituent of mine from Abronhill in Cumbernauld, is a young woman whose dystonia condition means that she requires the use of a wheelchair and needs a range of different appointments at clinics in several hospitals and NHS facilities. Catherine has battled with her condition for some years. She is a positive and inspirational young woman who is determined to remain as independent as possible. Such is her determination that she supports students at Cumbernauld College who have physical disabilities.
For several months, Catherine has had severe difficulty in arranging transport to appointments with her neurosurgeon and her physiotherapist, for wheelchair assessments and so on. The problem appears to boil down to the fact that different hospitals hold different agreements for non-emergency patient transport. For some appointments, Catherine is defined as a patient who, because of her disability, requires assistance from a two-person crew and who must be transported by ambulance; for other appointments, her disability merits only a one-person crew. That is unacceptable to Catherine, as she knows that one person is unable to manage her transfer safely and that that puts additional pressure on the people who arrange to take her to her appointments. Worst of all, sometimes no transport is available at all. I am sure that the cabinet secretary will appreciate that my constituent is understandably distressed about the situation, which does not help her in her constant battle to remain independent.
Catherine is not alone in having difficulty with the administration of this vital service. The confusion about the policy means that ambulances turn up at the wrong time, hospital appointments are missed, and consultants' and patients' time is wasted. Although I appreciate that the Ambulance Service must deploy scarce resources effectively to the maximum benefit of patients, the cabinet secretary must appreciate the waste of resources, effort and hope that this situation is creating.
Does the cabinet secretary recognise that non-emergency patient transport is a serious concern for the Scottish public and that it merits scrutiny? Will she explain to Catherine and to others who are in her position why non-emergency patient transport policies seem to vary depending on the location and type of appointment? Finally, will the cabinet secretary guarantee that Catherine's ambulance to take her to her next west of Scotland mobility and rehabilitation centre appointment will turn up at her house at 8 o'clock on 23 May? That is the kind of pressure that someone such as Catherine is under as, to make that appointment, she will have to be up at 5 o'clock in the morning. Sometimes she is let down by the services that are supposed to assist and protect her.
In this important debate, the morale of ambulance personnel and patients are in all our thoughts, but I will concentrate on some remote and rural Highland issues that flag up the problems that we have with the management of the service today.
I have a quote from the north and west Sutherland local health partnership meeting that was held on 1 May in Tongue. Andy Fuller from the Scottish Ambulance Service Highland said:
"The Agenda for Change agreement has caused a lot of issues for staffing ambulances locally, as the on-call payment, overtime rates and call-out payment rates have changed. Currently there is no method available with the Agenda for Change payment system to reflect potentially local solutions to remote and rural locations."
We have inherited this system and we have to work within its constraints. That has led to an Ambulance Service that is working to budgets that are constrained but not necessarily to standards that are suitable for patients. That manifests itself in the fact, which was mentioned by Mary Scanlon, that staff are not allowed to cover other shifts if they are on leave, which leads to a shortfall in cover and single crewing. In the west of Lochaber, it is reckoned that 60 per cent of ambulances will be single crewed until September because of that problem. As there will be only one member of staff fewer covering Strontian or Glencoe, there will be no potential for cover through overtime. That is the nub of the problem that is faced by people in two parts of the north and west Highlands.
The agenda for change is at the root of these problems and we need a Scottish solution for Scottish problems.
I thank Rob Gibson for raising the point; it is a real issue. The agenda for change system that we inherited has inherent problems in remote and rural areas. We are currently in discussion with the Scottish Ambulance Service about those issues to ensure that we get the resolution that Mr Gibson and others are seeking.
I thank the minister for that point. By airing these issues in the chamber, we are getting closer to the truth.
I also have notes from other meetings between the Ambulance Service and community councils. Mr MacLeod, who is the area manager for west Lochaber, spoke to the West Ardnamurchan community council on 5 May.
"Mr MacLeod was asked about relief cover, he stated the problem remained ‘funding'. Staff turnover was also a problem and a new pay mechanism has had an impact on the service. Relief staff are based in Fort William and Glencoe, there is an annual deficit of 1200 hours."
A committee inquiry and report would allow plenty of time to evaluate such facts from across the whole country. It is important to provide time for that in Parliament so that it leads to a debate. Our problem is this: if ambulance staff are removed from Kinlochbervie, for example, to make up the numbers in Wick so that the targets in Wick, which is a town, can be met, is it a success that calls in Wick are answered in seven minutes or a failure that it takes an ambulance more than two hours to reach someone on the west coast?
The cabinet secretary is correct that we have to have a change in the approaches that are taken. When she met the trade unions in Inverness, they were
"gobsmacked by the positive response from the minister … The meeting went superbly well. She was very supportive in the sense that if there was any wrongdoing by the management, she wanted to know."
That is the nub of the issue, and the Scottish National Party's amendment covers the way forward.
I rise to speak in this important debate to support the Labour Party motion. As other speakers in the debate have done, I start by paying tribute to the important role that is carried out in our communities by ambulance workers.
The central issue is how we deploy ambulance services most effectively to serve the public in emergency situations. Concerns have been expressed throughout the chamber about the reduction in the number of double-crewed ambulances throughout Scotland. People call on ambulances to deal with emergency situations where lives are often under threat and people need a quick response from a fully equipped ambulance. In those circumstances, single units do not provide what is required. When they reach the scene, they provide a temporary solution and they are often unable to move the ill or injured person. That undermines the effectiveness of the service.
We also need to consider staff safety. Sadly, emergency services are called out to scenes where violence has occurred or is occurring. That is particularly difficult if a single-crewed unit attends; unaccompanied staff should not be exposed to such situations. Our staff have key skills and expertise and provide quality care, so it is important that we back them up and ensure that they are protected.
As other members have said, the trade unions have expressed concern that patient care is becoming a casualty, that vacant shifts are not being covered because of budgetary restrictions and that, because of staff reductions, training and health and safety are being compromised. Those are issues of concern.
The question has to be posed whether the new arrangements are cuts or efficiencies. Efficiencies are a big theme for the SNP, which proposed £1.6 billion of them. Such a large figure had to be put in place because the SNP overpromised in its manifesto commitments.
The changes that we are discussing seem to be quite a clever scheme. They allowed the First Minister to stand up last week and say that there are more ambulance crews in the streets of Scotland than there were previously. No doubt, when the scheme was discussed around the table, it seemed to be a wise way forward, but if patients' lives are in danger and they are required to wait when there is a delay in a twin crew turning up, it is not an efficiency saving—it is a cut.
The debate is important and it has allowed members to discuss their concerns about the Ambulance Service. It stands to reason that if the number of double-manned ambulance crews is reduced and they are replaced with single-manned units, it will undermine the service and put staff at risk. Those are serious issues and it is time to think again about them.
I, too, welcome the debate, as it gives me an ideal opportunity to put on record my thanks to, and appreciation for, the front-line ambulance staff who are based at the station in Livingston. I visited the station recently and I have accepted the staff's very kind invitation to join them on a night shift one weekend. I look forward to doing that.
Having listened to front-line staff in Livingston, I certainly hope that the Health and Sport Committee will undertake a review of the Scottish Ambulance Service. Personally, I feel that such a review would be timely, as it would follow on from last year's Audit Scotland report on out-of-hours services. In that report, Audit Scotland correctly highlighted the need to improve the links between the out-of-hours service, NHS 24 and the Ambulance Service. The report emphasised the need to strengthen communication and, crucially, it urged a review of the impact of the out-of-hours service on the Ambulance Service.
I note and welcome the eight-minute target for category A call-outs, which is all very laudable, but I believe that additional, more sophisticated performance indicators are needed. Surely if an ambulance crew does not arrive within eight minutes but succeeds in saving a life, that is a good result in anybody's book.
Responding to emergencies day in, day out requires physical, emotional and mental strength. It is unacceptable that staff struggle to get meal and refreshment breaks, especially when they are working a 12-hour night shift.
When describing the challenges of their work, Ambulance Service staff repeatedly iterated to me that they felt that calling out an ambulance seemed to be the default position. NHS 24 appears to be the regular culprit behind inappropriate call-outs. Telephone assessment based on buzz words can be a rather blunt instrument and compares poorly with face-to-face clinical assessments. In addition, as we all know, A and E targets for vacating hospital beds also have an impact on the Ambulance Service.
My constituency is semi-rural in parts but, with the growth of Livingston new town and the core development areas, the constituency has one of the fastest-growing populations in the United Kingdom, never mind Scotland. St John's hospital at the heart of my constituency has the highest rate of hospital-to-hospital transfers in Scotland, as evidenced in a recent national audit. All of that, combined with the removal of some acute services from St John's hospital to the Edinburgh royal infirmary in 2004, has had huge resource implications for the Ambulance Service in my constituency.
Increased journey times are a real issue. The increased number of journeys between West Lothian and Edinburgh has implications for equity of access for my constituents, as ambulances are increasingly caught up in out-of-area call-outs. That is a cruel reminder of the consequences of not keeping health care local.
With the 60th anniversary of the national health service approaching, we need to keep health care local if we are to be true to the NHS's founding principles. The SNP Government can be proud of its policy of keeping health care local. I urge the cabinet secretary to continue to pursue that policy with all her vigour.
The problem is that we already have single manning in my constituency. In a recent incident, the doctor from Scourie had to get in the back of the ambulance and leave the area and ride down the road to the hospital. What would have happened if someone in the area had taken a heart attack? It is too bad to think about. In another incident, the Kinlochbervie ambulance unit had to be joined by the man from the neighbouring ambulance unit at Bettyhill to make up a double-manned unit. However, that merely passes the problem along the north coast to Bettyhill. Even more ludicrous still, we had an incident that two single-manned ambulances had to attend and which required one ambulance man to get in the back of the other ambulance. The net result was that an ambulance was left parked up in the middle of nowhere. What does that say about the NHS? Finally, only three weeks ago when a road traffic accident involving a lorry happened just outside Ullapool, the Ullapool team had been stood down by the management so the ambulance had to come all the way from Dingwall—a journey of more than an hour—to attend to the people, some of whom were severely injured.
Why do we have such serious problems? As members have mentioned, one reason is the package of rewards whereby ambulance staff are paid for 28 hours and given a rather small sum for their time on stand-by. We know that we do not have enough paramedics, but many of the existing paramedics do not have the time to update their qualifications because they are too busy covering other ambulance men. Therefore, they fall off the list of paramedics. It was put to me this morning—probably by the same ambulance man who spoke to Mary Scanlon—that the remuneration package, quite frankly, does not encourage technicians to become paramedics. People know that it is just not worth the candle.
What has been done about the situation? In fairness to colleagues from all parties, MSPs have made repeated representations about the service in both the current parliamentary session and the previous one. Repeated representations have also been made by local doctors, who are, after all, at the sharp end of the problem.
Rob Gibson mentioned the Kinlochbervie situation. I want to go into that just a little further. What happened was that—ta-ra, ta-ra—a fifth man was put into Kinlochbervie. However, as Rob Gibson said, he was then taken out—oh no—to cover a shortfall elsewhere. With sickness and with leave, we are back to something very like single manning in Kinlochbervie.
It may not be entirely fair to say this, but from a Highland perspective it looks as if the money that is being invested is simply to reduce the response time from nine minutes to eight minutes—or from eight minutes to seven minutes. However, such response times do not have an awful lot of meaning where I come from. It has been put to me clearly that, but for the grace of God, something far worse could have happened when the GP was not in the area or when an ambulance had to be left parked up in the middle of nowhere. Cabinet secretary, what message does that send to my constituents? It is not a good one, particularly for an ageing population. Indeed—just thinking sideways for a second—what message does it send to tourists that, if they become poorly in Sutherland, they might wait a very long time before they are taken to a hospital?
To use an expression that I used in the debate on the maternity hospital in Wick—I will not bore members with that just now, as we won that one—we should recognise that God, the good Lord, made the geography and we cannot get round that. In inclement weather, we face very serious problems indeed. If the cabinet secretary wants to check that with one of her colleagues, she should speak to Mike Russell. I remember meeting him at the Durness games, where, unfortunately, he hit his head on a low roof beam and found it quite a palaver to get a local doctor. He can speak with some experience.
With all due respect to the minister—I accept that she showed generosity of spirit in listening to my representations only last week—all that has been said about the improvements in the service ring somewhat hollow for people in my constituency, where we have real problems. I am speaking in today's debate because my constituents want me—and all of us—to sort out the problem. For that reason, I warmly support the amendment in the name of my colleague Ross Finnie.
The amendment in the name of the Cabinet Secretary for Health and Wellbeing seems to be unhealthily oblivious to the many concerns emerging across Scotland that are being brought to the attention of members of all parties. Now is not the time for back-slapping all round. No one is yet blaming the cabinet secretary for any deteriorating position, but if she simply takes the view that not much is wrong, they certainly will do. I am relieved that her opening speech showed more understanding of the situation than does her amendment. We all support the staff who do an invaluable job for the Scottish Ambulance Service but, as we might have observed in the motor industry, the enamel on the paint work is chipped, the vehicle is in need of an urgent inspection and, if nothing is done, we risk seeing the big end go.
I have been contacted by constituents about their recent experiences. In one instance, when the ambulance turned up, my constituent was asked to sit with the driver to direct the way to the hospital. In another instance, a relative was asked to lead the way by driving in front of the ambulance. On both occasions, the ambulance drivers were strangers to the area and did not know the location of the hospital. Other members have referred to such experiences in the many letters, e-mails and representations that they have received.
Written answers that I have received to parliamentary questions show that the overall number of vehicles in the Scottish ambulance fleet has dropped. That has been explained as a drop in the number of auxiliary vehicles rather than of ambulance and response vehicles. However, I am bound to point out that, as journey time consequences take effect as a result of the consolidation of A and E services and the cross-city travel that is required for the new Victoria hospital, substantially more vehicles may be required in Glasgow and the west of Scotland.
Nor is it acceptable to be breezy about the implications of single-manned rapid response vehicles. In the response to another parliamentary question, I learned that the number of incidents of violence and aggression towards ambulance staff has soared by more than 450 per cent in the past three years in west-central Scotland. Over the same period, the number of complaints against the Scottish Ambulance Service has increased by 120 per cent. Attempts to arrange a meeting with the chief executive have been fobbed off with suggestions of meetings with local management, which have subsequently been postponed.
Meanwhile, I have raised the plight of volunteer drivers, who are a vital resource for the ambulance service. I have been contacted by many such drivers, who are in despair because they feel that, given that there has been a 17 per cent real-terms fall in the mileage rate payable over the past year alone, they are now subsidising the service. As a result, there has been a 14 per cent fall in the number of volunteer drivers, and many more tell me that they are close to giving up. That is a dreadful situation.
This month, in response to another written question, I was told that the Scottish Ambulance Service had no plans to review the rate payable. However, the answer added, somewhat enigmatically, that
"the service was asked to look again at this matter, and have confirmed that they will now be reviewing the rates".—[Official Report, Written Answers, 13 May 2008; S3W-12662.]
By whom was it asked to look at the matter again? There is no point in the cabinet secretary suggesting that the service should have autonomy and recommending that the Health and Sport Committee should investigate matters if, at the same time, the Government is directing the service to review mileage rates and other matters.
All this is potentially tragic for patients. Volunteers are an essential element of the service. Patients already wait for ages, often in distress, because they are not deemed to be of sufficient priority. What are their prospects if we lose more volunteers? As hospital services are merged, might not we need more volunteers?
The debate is not an attack on ambulance staff, who do an outstanding job. It is an opportunity to air a series of concerns that, it transpires, has been growing among members. The cabinet secretary should acknowledge that, collectively, those concerns amount to more than a row of beans.
The cabinet secretary is due to hold her annual review with the Scottish Ambulance Service on 12 August. Yesterday she made the welcome announcement that the opportunity for the audience to participate in the review will be extended to allow spontaneous contributions from the floor. We must hope that questions will not have to be pre-submitted and carefully vetted, and that they will not be ruled out of order. If the review event on 12 August is sufficiently well advertised, I hope that members of the public will turn out.
Meanwhile, the cabinet secretary must turn her urgent attention to a service the performance of which might well be improving against certain measurements, but which is spluttering overall. Someone needs to get a grip, and the Parliament needs to be satisfied that someone has done so.
I thank everyone who has taken part in the debate.
In response to Ross Finnie's remarks about parliamentary scrutiny of ministers, I state categorically that I accept my responsibility for the Scottish Ambulance Service and, for that matter, for any other NHS board. Jackson Carlaw's comments about volunteer drivers' mileage rates demonstrate my acceptance of that responsibility. I clarify that the reference in my amendment to "autonomy" is to the autonomy of the Health and Sport Committee rather than of the Scottish Ambulance Service.
I will be happy to make a full statement on the issue to Parliament and to follow that with a parliamentary debate—although such matters are for the Parliamentary Bureau to make decisions on. Such is my happiness that I will vote for the Liberal Democrats' amendment, although I would still be delighted if the Health and Sport Committee decided—autonomously—to hold an inquiry on the subject.
I welcome the fact that the SNP will support the Liberal Democrats' amendment, but does the cabinet secretary accept that part of the argument has involved questioning the achievements of the Scottish Ambulance Service? My concern about the SNP's amendment as it stands is that it takes those achievements for granted and does not indicate that they need to be thoroughly investigated. There are serious concerns about that.
Perhaps what I am about to say will reassure Margaret Curran. A number of points have been made in the debate. Although shortage of time will not allow me to respond to them all now, I give the Parliament an assurance that I will investigate each and every point that has been made and, when appropriate, will respond directly to the members concerned and in the statement to which I have referred. That is right and proper.
Although all the points that have been made deserve to be treated seriously, there is a distinction to be drawn between situations that are inherently wrong and unjustified and issues that have arisen as a result of the Scottish Ambulance Service's efforts to improve performance. Into the first category I would put the single manning of ambulances that should be double crewed, on which I have commented, and, if it were true, the dropping of shifts to cut costs, but it is not true that that is happening. Shifts are being reorganised, because the reality is that the Scottish Ambulance Service is now better able to predict demand on a day-to-day, hour-to-hour basis than it used to be, which means that shifts can be organised more sensibly. The traffic light system that Mary Scanlon mentioned would belong in the same category, if such a system existed, but I am happy to give the member an assurance that no such system operates in the Highlands. I will take extremely seriously all the issues in that category.
The issues in the other category—which I am not suggesting do not still require to be scrutinised—are those that relate to deliberate developments by the Scottish Ambulance Service in an effort to improve performance. Rapid response units fall into that category. Let me be absolutely clear about the distinction between the single manning of ambulances that should be double crewed and rapid response units. Rapid response units are not substitutes for double-crewed ambulances. They are designed to ensure that patients get as quick a response as possible and that back-up is provided when it is required.
That is not an attempt to score a party-political point; it is a simple statement of fact. The rapid response unit has not been introduced by this Government over the past year; it was introduced by the previous Administration in 2002. It is important to acknowledge that.
Will the cabinet secretary give way?
I want to get through as many points as I can; I will come on to Cathie Craigie's point.
How does the cabinet secretary know what my point is?
I want to have time to get to the important point that Cathie Craigie made in her speech.
To Cathy Jamieson, I say as gently as possible that no heart attack patients would have been able to go to Ayr hospital if her Government had got away with its plans to close the accident and emergency unit there. I will respond directly to the point that she made. Heart attack patients are treated in line with Scottish intercollegiate guidelines network guideline 93, which I urge members to read. Patients who need angioplasty and who are stable enough to be transferred to the hospital that is best placed to administer that intervention go there directly. If not, they are transferred to the nearest A and E unit. Treatment can be administered in ambulances—I inform Mary Scanlon that all paramedics are trained to deliver thrombolysis.
Will the cabinet secretary give way?
I do not have time to take any more interventions.
Extremely important points were made by Nigel Don and Rob Gibson. I am acutely aware of the challenges that are faced in delivering an ambulance service in remote and rural areas, which is one reason why I visited Wester Ross just last week. The Scottish Ambulance Service is keen to consider innovative solutions to those challenges. I discussed ideas such as those that Nigel Don suggested with members of the community in Wester Ross, and I will be happy to discuss them with the Scottish Ambulance Service.
I say to Cathie Craigie that I acknowledge the importance of the non-emergency ambulance service; it is important that we do not forget it. Whether transport is required is a clinical decision, so there is a degree of variation. However, it is important that the Scottish Ambulance Service works with territorial boards to ensure consistency of service for patients. That is one reason why the service is investing in more mid-tier ambulance vehicles.
James Kelly made important points about the safety of staff, which is paramount. As regards what Angela Constance said, I appreciate that the eight-minute target is not the be-all and end-all, but it is based on international evidence and, as such, is an important target.
Time does not permit me to deal with the many other points that were raised. I repeat that I will investigate them all, and I look forward to taking part in further full discussions in the Parliament.
All members have made it clear that we commend the work of the Scottish Ambulance Service, the staff of which have risen to many challenges over the past decade. It is the only health board to have achieved level 3 performance under the NHS Quality Improvement Scotland standards. We must acknowledge that the service has an excellent history. Members have praised the present staff for their efforts.
There have been challenges. Members have mentioned thrombolysis, for example, and requiring treatment in the golden hour. Primary angioplasty, which requires patients in the Glasgow area to be transferred to the Golden Jubilee hospital and patients in the Ayrshire, Arran and Lanarkshire areas to be transferred to Hairmyres, is a new challenge. There is the problem of increasing demand—as Mary Scanlon said, demand rose by 12 per cent last year, on top of rises in previous years. In addition, there is greater need for intervention by paramedics rather than by technicians.
As well as those clinical challenges, there have been administrative challenges, which other members have mentioned. Agenda for change, which staff, management and Government agreed in partnership was the appropriate way forward, cannot always be applied to all areas satisfactorily. As with any national scheme, the geography of the rural areas needs to be taken into account. Nigel Don and others mentioned that.
The change in the call centres has been a challenge, as has the fact that sickness levels are still at 5.5 per cent, when the national target is to get them down to 4 per cent. Financial challenges are faced in information management and technology. Fuel prices, which have not been mentioned much, and modernisation are important issues, too. On top of that, the Government has imposed a 2 per cent efficiency target. Although the service gets to keep the savings, achieving them is an additional challenge to management in a service that already faces major challenges. James Kelly referred to that.
In the past, all the challenges have been met through an effective partnership between Government, management and staff. Reports from bodies such as Audit Scotland have shown how well the service is doing financially and in other ways. However, it faces an additional financial challenge in that its budget uplift has reduced from around 6 per cent a year during the Labour-Liberal years to 4 per cent a year. In last year's annual report, Nicola Sturgeon referred to the 12 per cent increase in demand, but went on to talk about the
"disappointing performance against the target set … to reach 75% of category A calls within eight minutes",
as the eight-minute target was met in only 55.7 per cent of cases. The cabinet secretary can now say that a 74 per cent rate has been achieved and that we are within striking distance of the target that was set. However, if a service that is under the stresses that I have mentioned moves from 55 to 74 per cent, that makes one wonder what is going on. Is it a tick-box exercise, or is the service not only meeting the target, which we all agree is important, but improving the patient experience?
Yes, the Labour Government introduced the rapid response vehicle system, but it has been expanded beyond all recognition to meet the target. That rate of expansion is causing enormous stresses and problems and is almost certainly leading to deterioration in the patient experience. If a single-manned motorcycle or car arrives at an incident, what can that one person achieve in a serious situation? They can achieve something and many are experienced—[Interruption.] The cabinet secretary shakes her head, but the most recent information we have is that not all the vehicles are manned by paramedics. In Glasgow, 80 per cent were manned by paramedics and 20 per cent by technicians. If somebody has a very serious issue, which would they prefer? Angela Constance was absolutely correct about that. If I was a patient having a serious heart attack, I would prefer a double-manned vehicle with paramedics rather than a single-manned vehicle with a technician who could not meet my requirements. The cabinet secretary keeps shaking her head, but those concerns are being expressed to many members by the public and, more important, by ambulance crews. The reduction in double manning, with a reduction of 70 shifts in Glasgow, rather than just the rapid response system, must be considered carefully.
That is one of the core issues, but staff have raised other issues, about cleaning, training and safety. More important is a letter from the staff, dated 21 May. I should declare that I am a member of Unite. A press release from Unite states:
"Partnership working in the Service was always amongst the most forward thinking within the Health Service in Scotland".
Today, I have received a collective grievance letter from staff. The Unite press release mentions the possibility of strike action, if those grievances are not tackled. I appreciate that the cabinet secretary has not seen the letter and that it is not reasonable to ask her to respond to it now. However, we have moved from a service with one of the best records in the health service to one in which there is
"a bullying and harassment culture"
and a feeling that jobs are under threat. That situation has, in part, led to the collective grievance being registered.
I put on record, as I did earlier, that I would not defend the situation that Richard Simpson has outlined, which is unacceptable. I repeat what I said in my opening remarks: I will take those allegations very seriously indeed.
Dr Simpson, you must come to a close, please.
I thank the cabinet secretary for that, but the point is that by pushing for the eight-minute target to be reached in 75 per cent of cases in one year, we have put enormous pressure on the management. We need a far deeper and greater understanding of that.
I do not have much time.
You must close, please.
Right. I am sorry that I do not have time to cover rural manning and other issues.
The suggestion in our motion is the appropriate way in which to proceed. We need an independent investigation of the issue now, before the service breaks down.