Air Ambulance Trials (Orkney)
The final item of business today is a members' business debate on motion S2M-3877, in the name of Jim Wallace, on air ambulance trials in Orkney. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes the proposal of the Scottish Ambulance Service to replace the Kirkwall-based BN Islander aircraft, successfully used for many years to provide air ambulance cover for Orkney, with an Inverness-based EC 135 helicopter which also covers a much wider area of the Highlands and Islands and beyond; further notes that trials of the helicopter on service in Orkney, carried out since spring 2005, have done little to provide assurances that it can provide even an equal level of service to that provided by the Islander aircraft, with particular concerns relating to its ability to fly in Orkney's winter weather and also its ability to provide adequate cover for the wide area it will be required to serve, and believes that, if the Kirkwall-based Islander aircraft is not retained as a back-up facility beyond the end of March 2006, Orkney will be left with poorer quality and potentially unsafe air ambulance cover.
I welcome the opportunity to debate the issue—which is important to my constituents—of the air ambulance trials in Orkney. I thank colleagues from all parties for staying to take part in the debate and, I hope, to support the case that I am making.
It is worth making clear at the outset that the outcome that I am seeking for Orkney is the retention of the Kirkwall-based Islander as a back-up to the EC135 helicopter. Andy Kerr's starting point, when we first discussed the issue last year, was that the service should be better, but the Scottish Ambulance Service and the minister need to recognise that the helicopter has shortcomings in some areas when compared with the Islander aircraft, so that helicopter-only cover—which is what the SAS proposes—would leave the islands without air ambulance cover when the helicopter could not fly but the Islander could.
The aim must be to provide an ambulance service that allows patients who are in need of medical attention—whether or not it is a life-or-death emergency—to be taken to the appropriate hospital with the minimum delay. That means having an ambulance service that is designed to cope as well as possible with the weather conditions in Orkney, day and night, summer and winter. The helicopter alone cannot provide that service.
Andy Kerr has confirmed to me that the helicopter is not cleared to fly in icing conditions, although the Islander can fly in icing conditions. That means that the helicopter will have to fly below the clouds when there are icing conditions. According to met office statistics, Kirkwall is 10 times more likely than Inverness to have a cloud base below 1,000ft. Combine that low cloud base with normal winter weather, and icing becomes a very real issue. Those with experience of flying in Orkney year in, year out believe that there will be a significant number of days when the helicopter will not be able to fly, but when the Islander could fly.
Whereas the pilot of the Kirkwall-based Islander can make his own judgments on whether it is safe to fly when air traffic control at Kirkwall is not available to provide weather information, an Inverness-based pilot would have to face a delay while the ATC staff at Kirkwall were called out. Furthermore, an Inverness-based pilot is not best placed to take advantage of the short weather windows that a Kirkwall-based pilot, with their experience of local conditions, could use.
There are real concerns that the single Inverness-based helicopter, which has to cover more than half of Scotland as well as Orkney, will be overstretched. In December last year, there were three night missions to the north isles of Orkney that the helicopter was unable to undertake. Two were covered by the Islander, the other was covered by the coastguard helicopter. It is not clear whether the helicopter was unavailable because of work elsewhere or whether the problem was to do with the weather. Whichever it was, in the space of one month, there were three times when the helicopter was not available.
The helicopter has limitations as to range. It cannot fly from Inverness to the north isles of Orkney and on to Aberdeen without refuelling at least once. That delays the transfer of a patient to hospital and makes the helicopter dependent on weather conditions at an intermediate stop. I am told that on one occasion it refuelled in Kirkwall with the patient still on board, sitting in freezing air as the door was left wide open. The Islander, on the other hand, can fly from Kirkwall to the north isles and then south to Aberdeen without the need for refuelling stops. The helicopter cannot, at present, take a pregnant woman who has gone into labour, and there is not the same space in the helicopter as there is in the Islander for family members to accompany children or elderly people.
No doubt the minister will try to claim that the helicopter has met its performance targets, but most of the flights it has undertaken have been deemed so-called planned flights, not emergencies. Planned flights do not have to meet the same performance targets as emergencies. Orkney patients in need of hospital treatment have increasingly to wait because the air desk often asks doctors to delay an evacuation if it is not a life-or-death situation. Patients might not die as a result, but one general practitioner from the isles told me:
"I was questioned closely regarding the urgency, presumably so it could be so classified. This led to concerns as, though conditions may not have been life threatening, two extended waits caused considerable prolonged discomfort for patients and distress for relatives."
By "waits", we are talking about hours, not minutes. A nurse, reporting a long wait for the arrival of the helicopter on one of the north isles, said that she had to phone air ambulance control three to five times to get an estimated time of arrival. She said:
"I also phoned for an air ambulance at 11 pm for immediate dispatch and was asked, ‘Could it not wait until the morning?'"
The high incidence of the helicopter's flights being given planned status rather than emergency status means that the helicopter has not been properly tested in the trials against the emergency criteria.
This is primarily an issue on which I am arguing on behalf of my Orkney constituents, but a Kirkwall-based Islander can benefit other areas, too. Given the weather restrictions on the helicopter, there will be times when the Islander will be able to assist elsewhere. For example, on 11 February this year, it was called to take a patient from Stornoway to Inverness in conditions of low cloud with icing at altitude. Flights from Kirkwall to hospitals in the south are generally undertaken by the King Air, but there are times when the crosswinds on the main runway at Kirkwall will not allow the King Air to land, although an Islander back-up aircraft could use the shorter cross runway to take off and take a seriously ill patient south.
I will end by outlining the reports that I have received from those with direct experience of the helicopter: north isles GPs and nurses who have worked with the helicopter during the trial. Before I do so, I point out that the minister said that the Scottish Ambulance Service would not be contacting those GPs and nurses directly, so I undertook my own survey.
Will the member take an intervention?
No, I want to get on.
So far, five GPs and four nurses have responded. Together, they have experience of about 50 helicopter missions. When they were asked whether they were concerned about the prospect of the loss of the Islander, all but one said yes.
I have focused on the logistical and health-related reasons for retaining the Islander as a back-up. I believe that those reasons are strong enough in their own right. Time does not permit me to develop the point about the significant knock-on cost to Orkney Islands Council for its inter-isles air service as a result of the loss of the Islander performing air ambulance services—so much for joined-up and efficient government.
I ask the minister to listen to the following messages from the medical staff on the front line in Orkney's north isles. One GP said of the Islander:
"Without exception the arrangements went very smoothly—one phone call and a very quick response time."
However, he went on to say:
"Unfortunately the same cannot be said for the helicopter. I have had a number of difficulties arranging patient transfer, these include slow response times."
Another GP said:
"I am very concerned about losing the Islander air ambulance. From the islands we need a means of transport, not a mobile intensive care unit."
That was backed up by another GP who said:
"The principal need is for speed of transit to Kirkwall … I am most concerned over potential delays through availability, distance and weather conditions. We have been much better served by local pilots using the familiar and proven Islanders."
The case might well be made that the helicopter is fitted out, modern, state-of-the-art technology, but, as one constituent said to me, it can be as fitted out and state-of-the-art as we like, but if it cannot get here, it is not much use.
The new contracted service is a step back, not forward. It fails the test of being a "better service". I ask the minister and the Scottish Ambulance Service to think again.
l warmly congratulate my friend and colleague Jim Wallace on securing the debate and demonstrating, as a constituency MSP raising legitimate issues in this forum, the importance of the members' business slot. The parallels between the concerns articulated by the constituents of Orkney and the constituents of the Western Isles will become all too apparent in the next few minutes.
The constituency that I represent owes a great debt to those who man the air ambulance service. Every year, about 400 of my constituents have first-hand experience of that vital service. We are grateful not only to the air ambulance service but to the coastguard helicopter for its timely and often courageous interventions in saving life and limb.
It is precisely because the service is life saving that my constituents, particularly those on the island of Barra, are concerned about the prospect of the new service and the consequences of its beginning this April. The new aircraft, the King Air, cannot land on the beach airstrip, so the island will be reliant on a rescue helicopter—the Eurocopter EC135. As recently as Monday of this week, islanders reminded me of the widespread concern on Barra about that prospect.
A number of fundamental questions have to be answered to restore my constituents' confidence in the impending service. First, can the new helicopter accommodate an escort travelling with a patient? That is a particular concern of parents, who dread being unable to accompany an injured or grievously sick child, but it also applies to the elderly, patients with learning difficulties and those with life-threatening injuries. Who will make the vital decisions in mainland hospitals in Glasgow and elsewhere if the relatives have not accompanied the patient on the journey?
Jim Wallace asked whether the helicopter could fly in icy conditions. There is a concern that the necessary flying altitude will mean that flights cannot take place even when the ground temperature is well above freezing.
Is the helicopter capable of transporting patients with head injuries and will its range and the need to refuel delay patient transfers? Will the helicopter be able to take patients from mainland hospitals back home to the island of Barra?
My constituents' concerns arise from the knowledge that in the recent past the aircraft capable of landing on the beach airstrip were replaced by a helicopter service. Within a short space of time, the fixed-wing aircraft were back in service because in practice the helicopter did not provide an acceptable alternative.
I welcome the fact that the new service promises improved comfort for patients. We all welcome that. We also welcome quicker response times and better access. The Scottish Ambulance Service states that the new standards
"represent an overall improvement on current service levels."
The minister knows the islands well. He knows Barra well and he knows Lewis well, having been born there. I am delighted to see that he is responding to the debate. The 1,200 people on Barra—like those on Orkney—need an assurance. They must place their trust in those who provide this vital service. I sincerely hope that tonight, or some time after the debate, answers will be given that will enable them to put their confidence in the new arrangements that will come into place this April.
I, too, congratulate Jim Wallace on securing the debate. I welcome the contributions that he and Alasdair Morrison have made to the debate; both of their testaments were convincing, factually rich, practical and deeply concerning.
I echo the concerns that Jim Wallace expressed about the adequacy of cover, the reduction in the robustness of the service and, especially, the ability of the EC135 helicopter to fly in winter weather. The last concern is particularly worrying, given the wide area that has to be served. As Jim Wallace said, it is hard to see the proposal as an improvement; it seems to be more of a step backwards. I am sure that the minister will want to address that key issue in his closing speech. As Alasdair Morrison said, the present Deputy Minister for Health and Community Care brings more empathy to the subject than others do.
I view the issue in a wider geographic spectrum. In common with Alasdair Morrison, I too would like to focus on Barra. I am grateful for the contributions that I have received from Councillor Donald Manford, Hugh Douglas, the chair of the Northbay community council, and from one local mother in particular, Mrs Mairi Campbell. The concerns that they have voiced to me are highly practical concerns about the capability of the fleet to match people's expectations let alone to match the current level and availability of service.
The proposal that the route to Barra from Inverness should be via a refuelling stop at Stornoway, with all the delays and problems that that may involve, is unsettling to say the least, especially as demand may reach a level at which other helicopters that are not only not designed for this work but have other conflicting roles to play have to be pressed into service. As Alasdair Morrison said, there are real concerns on Barra about a future in which planes are not available. The Islander aircraft has been proven over the piece to be much more weatherproof than the helicopter.
There are also current practical concerns about the helicopter's ability to carry escorts. I note from an article in today's Stornoway Gazette that John Morton of the Scottish Ambulance Service is trying to alleviate those concerns, but they will continue: people are worried about whether the need for an escort will have to be requested in advance, whether the weight of an escort will be seen as a critical factor and whether parents can regularly accompany children. Equally, there are concerns about the rumoured withdrawal of non-emergency return flights, which could result in people who are ill or recuperating being forced to find their own way back to their home island. The suitability of the helicopter to carry pregnant women has also been mentioned.
More fundamentally, when I looked again over the Scottish Ambulance Service's response to the consultation, I noted the nature of the way in which it handled the issues at the time. Its attempt to address all the concerns can largely be described as a woolly, work-in-progress statement that lacks practicality. The service's response has no clear criteria or completion dates. I can find neither an objective analysis that would have convinced potential users of its case nor a structured attempt to address the concerns of people in Skye and Barra.
If tonight's debate is about anything, it is about a request to have those concerns properly and fully addressed. We do not want the step back about which Jim Wallace and I are afraid; we want progression so that not only do we have fulfilment by the Scottish Ambulance Service but a commitment to perpetual improvement in services as we go forward. That is what will give people on the islands the security and confidence in the service that they require. It would also give a platform for the islands to be as effective as they deserve to be and in balance with the rest of Scottish society.
I, too, want to thank Jim Wallace for bringing the debate to the chamber. He has given members the opportunity to talk about this crucial service in the Orkney islands.
A visit to the ambulance station in Inverness can only leave someone immensely impressed with the level of technology that is used by its highly trained staff. The latest technology, coupled with expert local knowledge and understanding, is an ideal combination for our national health service. I hope that a similar balance can be found in the implementation of the air ambulance service for Orkney. However, like other members, I fear that invaluable local knowledge of the islands will be conceded to centralise the service.
The Scottish Ambulance Service maintains that the new service will improve access and medical treatment for patients, that it will be more comfortable and will have wipe-clean and sealed surfaces that will help to reduce the risk of infection. I am sure that everyone in Scotland would welcome more effective ambulance treatment and a more comfortable journey to hospital, by road or by air. Similarly, I am sure that people would welcome an upgrade of the existing fleet of aircraft, to take advantage of innovations. The concern that the people of Orkney have is that the vital role of the air ambulance fleet, which the Kirkwall-based Islander aircraft have fulfilled excellently for many years, will be compromised by the desire to improve standards.
I respect and commend the views of the elected members of Orkney Islands Council. I welcome the council's convener, Stephen Hagan, who is in the public gallery. The council has provided members with an in-depth report of councillors' views on the proposals and trials, which raises several serious concerns. We must first question the loss of the dedicated Orkney service. Given that the Inverness-based EC135 helicopter will cover a wide area of the Highlands and Islands, it may simply not be available for a large percentage of time to serve the needs of people in the Orkney islands.
Although the Scottish Ambulance Service maintains that journey times will not be affected and may in fact be quicker, the reality is that any aircraft that take off from Inverness will have to travel up to 120 miles or further to reach some of the outer islands. In an emergency, that extra distance could be dangerous. I also wonder whether patients from Orkney will be more likely to be treated in Inverness rather than in Aberdeen, as happens at present.
The Orkney Islands Council report also expresses concern that the EC135, which will be the focal point of the new service, is said to be of limited use in bad conditions, as Jim Wallace and others have said. It is anticipated that the aircraft will frequently remain grounded during the winter months because of its zero-icing operational requirement. Whether or not that is the case, the use of an aircraft that is difficult to operate in wintry conditions and that must travel almost twice the distance that the current service travels to reach many areas of the Orkney islands is a worrying scenario for patients and their families. We should also remember that in the poor visibility that is caused by high winds and rain—weather that is not at all uncommon on the Orkney islands—the local expertise of the current piloted service excels. The ideal situation would be a combination of advanced technology with the knowledge of residents.
Like other members, except perhaps Stewart Stevenson, I cannot judge the performance of aircraft but, following the outcome of the consultations and trials, the crucial point is that the new service must earn the confidence of people who live in Orkney and the Highlands. People must be assured that they will not be left with a poorer-quality and unsafe service. That is the concern that has been raised today and which I hope the minister will address in his summing up.
I call Eleanor Scott, to be followed by Rob Gibson, which is as it should be.
Thank you very much, Presiding Officer.
I am happy to speak in the debate. I signed the motion only yesterday, because I thought that I had signed it earlier, but I had not. I will speak primarily about the effect of the new arrangements on maternity services. I have two reasons for doing so: the first is that the subject is an emotive one and the second is that I know something about the maternity service in Orkney, as I recently visited the maternity unit in the Balfour hospital in Kirkwall.
The service provided at the unit is run by midwives and general practitioners; they are clear that it is a joint venture. I visited it because it is such a good example of working together to deliver maternity services in an island setting. It is an excellent service with a high level of patient satisfaction. One indicator is that it has far and away the best breastfeeding rates in Scotland. There are several pieces to the jigsaw of that excellent service: confident and committed midwives; confident and committed GPs; the joint training that the midwives and GPs undertake; and their trust in each other. Another piece of the jigsaw is the specialist back-up that the midwives and GPs receive from a big hospital—in this case in Aberdeen—which mainly consists of antenatal input, so that problems are identified early and any patient who has to go to Aberdeen for delivery does so on a planned basis.
There will always be occasional emergencies, which is where the changes are a cause for concern and where the midwives I have spoken to have identified potential problems. Under the current system, the plane is based in Orkney and is easily accessible. Although it has to leave the islands to make other runs, in practice obstetrics emergencies tend to be at night when the plane is there. The plane is generally rapidly available. Under the proposed new system, there is an obvious delay. A helicopter has to come from Inverness and, as the motion says and as Jim Wallace made clear in his introduction, it is likely to be much more dependent on the weather.
Other problems have been referred to, such as space. The helicopter is much smaller and there is concern that there will simply be no room for a doctor or nurse to attend to a patient's needs in flight, should that be necessary. The lack of space also means that if a midwife, doctor or nurse has to travel with the patient, which quite frequently happens in emergencies, there will be no room for a relative to go too. For that reason, during the trial of the helicopter three men were unable to accompany their pregnant wives. That is not an acceptable quality of service.
Because the helicopter is based away from Orkney, another problem is that a doctor or nurse accompanying a patient to Aberdeen has no way of getting back to Orkney. They will be stuck there, waiting for a scheduled flight to get home, leaving the service back on Orkney understaffed. It is not long since the Parliament debated the Kerr report—a document that has received broad cross-party support. It stressed the role of rural general hospitals. The Balfour hospital on Orkney could be an excellent example of such a hospital; it is a model that we should be developing. I have focused on maternity services, but I am sure that the same concerns exist in other specialties. If we are serious about supporting our rural general hospitals, we must provide them with access to the specialist back-up of the big centres, both on an on-going, planned basis—that is the easy bit—and in the emergency situations that will inevitably arise. People need to be confident that that safety net is there.
I agree with the motion and I feel that the proposed new arrangements represent a retrograde step and a reduction in the quality of service. As we have heard, areas other than Orkney have been affected and I ask the minister to reconsider the matter.
I am glad that Jim Wallace has secured this debate. I attempted to get a debate of this sort after December 2004, when those members who have researched questions on this subject will note that I lodged a motion similar to that of Jim Wallace. The arguments related particularly to Orkney, but also to the Western Isles and other areas. Since then, the air ambulance trials have taken place, but other information should perhaps have been taken into account. A study was carried out for RARARI—the remote and rural areas resource initiative—about a place on Arran that can only take helicopters to shift patients to the mainland. The study considered evacuations over the past 10 years and showed that there was no consistency among GPs in their reasons for calling the ambulance. It is obvious to us that certain aspects of maternity and so on are definitely emergencies; indeed, the professionals have a wonderful ability to decide what really is an emergency. The SNP is not suggesting that that should be redefined, but it would be helpful if the minister could consider how ambulance call-outs are dealt with and on what basis.
Does Rob Gibson agree that the downgrading of the air ambulance service compounds the position on Flotta, where there is no longer a resident GP, as it does on all the outer islands? The people on Flotta are even more disadvantaged by the downgrading and my sister, who is the head teacher there, has raised that issue at one of Jim Wallace's surgeries. We must not think that everybody in Orkney is in Kirkwall.
I thank Christine Grahame for those germane remarks. There are arguments about the reduction in the numbers of GPs in the islands, especially the outer islands. That is a slightly separate subject, but it will certainly have to be addressed to secure the islanders' interests.
The basing of aircraft on the islands, not at some central point, is central to the argument. It would be useful for the minister to compare how ambulance services in other countries handle such matters. It is fine if we have an airstrip that can be used. [Interruption.] I am glad that members from other parties realise that I am about to suggest that we consider the north of Norway. It is instructive that the service there is better manned, that it has a larger number of aircraft and that how it is organised causes less concern. At least, that was the situation on my visit to a medical conference in Norway last September and that was the kind of information that I was seeking. We should compare what we have with what other countries have, because the new contract gives us less than we had when I was writing my motion, more than a year ago.
Part of the problem with creating a dedicated service is that some of the contract relies on coastguard aircraft being available in emergencies. However, coastguard aircraft might not be available in precisely the kind of weather that we have been talking about, so how can we arrange the service to have fewer aircraft and be more reliant than before on the availability of coastguard aircraft? Fewer aircraft will not do. The idea that the aircraft could be based in Inverness and that it could be icy there, but not in Orkney or Barra, is another issue. If we are dealing with emergencies that are mainly in the islands—we can show from the figures that we are—we must rethink. I ask the minister to address that point. Scotland requires greater investment in appropriate aircraft, more of which should be based in the places that are most affected by severe weather. The Scottish Executive should ensure that a proposed new, best-value contract does not place lives in greater jeopardy than in the past.
I hope that the minister will address some of those points, which are germane to all our island groups and remote mainland areas.
I thank Jim Wallace and welcome tonight's debate on an important issue for Orkney. The provision of air ambulance cover for the islands was one of the key issues that council convener Stephen Hagan raised with me when I met him in Orkney last summer. It is of real concern to local people and I raised it with the Minister for Health and Community Care by writing to him on 15 September. In his reply in a letter to me dated 19 October last year, Mr Kerr admitted that there had been some teething troubles with the service.
I wonder whether the teething troubles to which the minister referred included the case, which is documented in Orkney Islands Council's report on the trials, in which the air ambulance was requested to transfer a patient with a severed artery—apparently with blood pumping from the wound—to hospital. Because the helicopter was on another mission, the air desk staff said that they would reply shortly with an estimated time of arrival. The doctor advised them that the case was urgent, but it was nearly an hour after the original request before even an ETA was given. The helicopter arrived 108 minutes after the request, and the time factor that is recorded on the statistics sheet is 120 minutes. However, in the statistics that Orkney Islands Council received from the SAS, the case was classed as being completed as planned.
Perhaps the minister was referring to another case in May—again, I will paraphrase the official document about the case. The air ambulance was requested to transfer a patient with a terminal condition to hospital. According to the doctor, the pilot stated that they would not fly due to cloud conditions. The air desk said that it could move the patient to Kirkwall but that the air ambulance might get stranded there due to the weather, in which case it would not be available for the rest of the evening. The doctor felt that he could not deprive someone else who might be in a life-or-death situation so he decided to wait.
I appreciate that those examples might be the exception rather than the rule, but they do little to instil confidence in the much-vaunted new level of cover. The chief executive of the Scottish Ambulance Service, Adrian Lucas, says that the claims that Islander aircraft based in Orkney and Shetland can respond more quickly are based on flight time rather than overall activation time. He based that view on the fact that the Inverness-based EC135 helicopter will be in the air in two minutes and, because it flies much faster, the overall response time from the initial request to arrival at the receiving hospital will meet the time standards. Does that mean that, if both the Islander and the EC135 were alerted at the same time, the EC135 would be able to travel all the way to Orkney, pick up the patient and return to Inverness in the same time—or less—that it takes the Islander to do the one-way trip from Kirkwall to Inverness?
Perhaps the Executive will provide us with a comparison of the average time for an Islander-based response and the average time for an EC135-based response, from the alert time to the patient's arrival at the destination hospital. Does the Executive have any figures on that?
I fully support the concerns of Orkney Islands Council convener Stephen Hagan, who said:
"Many people living in the isles will feel vulnerable when the new contract starts, especially those in our more remote areas. This goes against everything we're doing as a council to halt depopulation … Without adequate air ambulance cover this will be at risk. Everywhere in the Highlands and Islands area will have the service or back-up service based locally, except Orkney, which obviously raises great concerns."
People in Orkney feel that the Executive is not listening to their local concerns. Communities such as Orkney need to have confidence in their emergency health provision and the air ambulance is a crucial part of that. When I met Stephen Hagan, he suggested that the estimated cost of retaining the Islander on an emergency-only basis was about £100,000. I am not sure whether there is an updated figure, but given that the new contract to run air ambulances will cost £70 million over six to seven years, surely funding can be found to keep the Islander for use in emergencies.
Unless action is taken by 31 March, the security that the well-trusted Islander gives Orkney will end. Orkney Islands Council is concerned; politicians from all parties, including the Executive parties, are concerned; doctors are concerned; and, most important, local people in Orkney are concerned. The Executive should reconsider its position and allow the retention of the excellent Islander aircraft, which can land on a sixpence, to ensure that Orkney continues to be covered by its well-proven service.
I thank Jim Wallace for the opportunity to talk about flying, which is one of my favourite subjects. I will not disappoint my many fans in the chamber. I will try not to be influenced by the fact that my particular set of flying qualifications would allow me to fly the Britten-Norman Islander but not the EC135, although I have to say that in no sense do I aspire to fly in the conditions that are faced by the expert pilots who provide air ambulance services in Scotland. They do something that few pilots would wish to do, however highly qualified or experienced they are.
I will make one or two points about aircraft and equipment. The issue of icing has been mentioned. It might be of interest to members—or perhaps not—to know that the icing level above ground is 500ft for every degree Celsius by which the ground temperature is above zero. If the ground temperature is 3°C, the freezing level will be 1,500ft. It would be fair to say that in winter in the northern islands, there will be many occasions when the ground temperature is at or close to freezing. That does not automatically mean that there will icing in the air; there has to be cloud as well and it is only in cloud that icing will occur. On that basis alone, the Islander beats the EC135 hands down, although we should not overplay its ability to deal with ice because it can deal with only the lowest of the three categories of ice.
That brings me neatly to one of the things that I would like to bring to the minister's attention. When we went to the market to look for a contract for this service, perhaps we did so without taking the opportunity to look at new technologies and simply bought the technologies that happened to be available. For example, the King Air is a fine aircraft but because it has retractable undercarriages, it is simply unsuitable for landing on beach airstrips such as those that are used by the ambulance service in Mr Morrison's constituency at Northton in Harris, in South Uist and at Solas in North Uist, and of course by the regular commercial services that go into Barra and elsewhere. Virtually every island in Scotland has an airstrip; Arran is the only exception that I can think of at the moment.
If we were being challenging and ambitious—if we wanted to show the world—we would have specified the gold standard and seen to what extent we could achieve it. I suggest that that standard might be a Britten-Norman Islander with a piston diesel engine. Despite how that sounds, that is modern technology that is just coming into use. It is technology that can fly in all conditions. The engine can be started and stopped without any cooling-down time. It can burn any available fuel, so if the aircraft got to an island and was short of fuel, it could use fuel drained from the tank of a car or lorry. That is terrific in the bush-type flying conditions that the aircraft experience.
Will the member take an intervention?
I hope that Mary Scanlon is not going to ask a technical question.
No, but I am so bowled over by the member's expertise that I want to ask him whether he has offered that incredible advice to the Scottish Ambulance Service.
I regret to say that I have not and I suspect that the service would look at the information in a different way. All I am saying is that we should consider the new technologies that are out there and ask what we could do that would best meet our needs; fuelling is one of the issues to consider.
At the core of the argument is the real issue, which is where the aircraft is rather than what it is. If the aircraft is in the islands, the cloud base is at 100ft, the ground temperature is 0°C and it is icing at 100ft, the Islander can take off and fly. It cannot land again and it would be forbidden to conduct normal commercial operations under those circumstances. However, it is permitted to—and the pilots are prepared to—operate humanitarian missions under those circumstance. The EC135 cannae do that, and that is the bottom, middle and top of the issue. The issue is where the aircraft is, not what it is, and the aircraft need to be near the patients.
I welcome Jim Wallace's motion and the opportunity that it provides to address the changes that the Scottish Ambulance Service is planning to implement in its air ambulance service provision from April. As Alasdair Morrison said, these are important matters for all Scotland's islands, as I know from my background. Indeed, the service goes back to the time when my father was a boy on North Uist. The first air ambulance flight was from Islay in 1933 and there has been a continuous service to Scotland's islands since then.
Neither Scottish ministers nor the Ambulance Service would wish to compromise the service, but we should not assume that the means of delivery of the service are beyond improvement. That is why, since 2003, the Ambulance Service has been engaging with service users and other key stakeholders, including health boards and local authorities, in preparation for a new service contract to begin later this year.
When the consultation began, the Scottish Ambulance Service had already made significant changes in its provision of ambulance services. It had introduced a priority-based dispatch system for emergency telephone calls, which was informed in part by the work of the Audit Committee. It had created three new emergency medical dispatch centres—to which Mary Scanlon referred—that use the most up-to-date technology and are designed to improve the responsiveness of the service to those in greatest need.
The basis on which the emergency ambulance service operated was fundamentally changing from getting the patient to a hospital as quickly as possible to focusing on using the enhanced skills of paramedics and technicians to take high-quality clinical care to the patient as quickly as possible. The road accident and emergency ambulance units and the rapid response ambulance units are designed and equipped to support such an approach.
The consultation on air ambulance services that began in 2003 was intended to ensure that they too could deliver a service that is compatible with the overall direction of the Scottish Ambulance Service—getting the best-quality care to the patient. The tendering process sought to invite bids from companies that could provide aircraft to achieve those objectives. At its January 2005 meeting, the board of the Scottish Ambulance Service agreed that Gama Aviation with Bond Air Services be confirmed as the new air ambulance service provider from 1 April 2006.
The new service will be provided by two dedicated EC135 helicopters operating out of Glasgow and Inverness on a 24-hour basis, and by two brand new dedicated fixed-wing King Air aircraft at Glasgow and Aberdeen that have been designed for the required medical equipment.
Back-up for the outer Shetland Isles will be provided by BP using its Super Puma search and rescue helicopters. Further back-up will be provided by the Ministry of Defence and HM coastguard, as has been the case for many years when, for one reason or another, an aircraft in the service has been unable to complete its mission.
Will the deputy minister reassure us that the back-up aircraft have pilots on standby to fly them at all times?
The coastguard back-up is available around the clock. I will be happy to respond in writing to Mr Stevenson's inquiry regarding the Ministry of Defence. However, I expect that it would be covered in the same way.
As Jim Wallace acknowledged, the majority of missions that are flown by air ambulance flights are planned. In 2005, 310 out of the 340 Orkney air ambulance service missions were planned. Up to 96 per cent of those met established performance standards. Of the 30 Orkney missions in 2005 that were classified as emergencies, 27 had a timescale that was agreed with the requesting clinician. The Scottish Ambulance Service met the timescale in all but one case—a performance of 96 per cent against a target of 95 per cent.
I am grateful for the written answer that I received today from the Minister for Health and Community Care, Mr Andy Kerr.
The deputy minister referred to 30 emergency and 310 planned flights in 2005. The figure for emergency flights of 30 compares with a figure of 101 for such flights in 2004. Does that not give some colour to the widespread belief on the island that general practitioners have been pressured into redefining particular incidents as non-emergencies to fit in with the air ambulance's convenience?
The performance standard is one that is agreed between the clinician in question and the air ambulance dispatcher. As has been indicated in several speeches, the GP or clinician in such circumstances has the final responsibility to make that judgment. Clearly, he or she should always do so with the interests of his or her patient firmly in mind.
Of course, there are occasions when time is critical. I will comment briefly on such cases, about which Jamie McGrigor asked. Both the EC135 and the King Air aircraft are available around the clock—24 hours a day—and have an activation time of two minutes. I understand that the Islander aircraft has an activation time of 60 minutes. Both the EC135 and the King Air aircraft are able to deliver patients to hospital within their set target times. We know that that is the case for the EC135 because the air ambulance service agreed to put the service in place in Orkney a year early, in order to test its ability to deliver patients on time and to standard. In general terms, that has been achieved successfully.
I am listening carefully to what the minister is saying. Does he conclude that the concerns that people in the Orkney Islands have expressed about the air ambulance service's new system are unfounded?
I would never diminish concerns that are felt either by elected representatives such as Jim Wallace, Alasdair Morrison and others from whom we have heard and with whom issues have been raised locally or by GPs. However, I recognise that changes in service always require all parties to work together to deliver them successfully. Concerns have been raised that will be addressed as the service is rolled out, but I hope that what we know from the 12 months of trials in Orkney will give some reassurance to members that some of the issues about which they are concerned will prove to be less serious than they anticipate.
For example, it has been suggested that weather will have a significant impact on the flying ability of the EC135. Over the past 11 months, there has been only one occasion when the Ministry of Defence helicopter has been deployed because the EC135 was unable to fly due to weather conditions. Jim Wallace referred to a number of other occasions. I understand that he will receive more detailed information about those in the near future.
Concern has been expressed about fuel and refuelling. I point out that, where necessary, the EC135 can fly from Inverness to the northern isles of Orkney, collect a patient and return to Kirkwall without refuelling, which is significant.
The issue of utilisation rates has been raised. The air ambulance is currently working at 13 per cent of capacity, so there are grounds for believing that capacity will be available.
A number of members raised the issue of the carrying of escorts. If the service is informed of the need to transfer an escort when the request for transport is made, it will do so. In its standard configuration, the aircraft is set up with three seats—two for the paramedics and one spare seat—so an escort can be accommodated. The same should apply in maternity cases. However, it is recognised that more needs to be done on the interior spec for carrying such cases. The Ambulance Service is working on the issue at the moment, with midwifery staff from the Queen Mother's hospital in Glasgow.
Officials will visit Barra tomorrow, and I hope that Alasdair Morrison will be able to meet them if he is in his constituency at the time. They will certainly be happy to meet him and council representatives to address any specific issues that they would like to raise. All of us recognise the importance of ensuring that the service that is provided meets the needs of islanders. I hope that, with continuing dialogue between local authorities, elected representatives, the NHS locally and the Ambulance Service, the remaining concerns—about which Mary Scanlon was right to ask—can be addressed to the satisfaction of the communities in question.
Meeting closed at 17:59.