Ambulance Service (Wick)
The final item of business is a members' business debate on the Wick ambulance service.
Motion debated,
That the Parliament recognises the vital work of the Wick ambulance service; is concerned at the lack of additional funding that was made available to the Highlands from the £22 million the Scottish Ambulance Service (SAS) received for modernisation; notes the long on-call working regime that means ambulance crews are often on duty for as much as 20 hours at a time and are routinely required to make long journeys of over 200 miles; is further concerned that crews suffer from sleep deprivation, possibly endangering themselves, their passengers and other road users, and asks the Scottish Executive and the SAS to urgently review the on-call working arrangements at Wick Ambulance Station, where staff are paid less than 90p per hour for being on-call, with a view to upgrading it from part-time on-call to full-time.
When eventually I finish work tonight, after we have concluded a short meeting on the Holyrood project at perhaps 7 o'clock or 8 o'clock, I shall drive home to the Highlands—a journey of 198 miles—and I shall be tired. One knows that that comes with the job. John Farquhar Munro and I make those journeys—we grin and bear it and we get there.
This morning, I spoke to an ambulanceman from Wick, who told me a story. Last Monday he worked from 8 am until 8 pm—a 12-hour shift—in Caithness. He went home at 8 o'clock, but at a quarter past 10 that night he was called out to do a return trip of about 200 miles—about the same as my driving home from here—to take a patient to Raigmore hospital in Inverness. He got back home at 5 am and was exhausted.
The intention behind my motion, which colleagues are being kind enough to debate today, is self-evident, but to flesh it out somewhat, let me quote from the 29 December 2002 edition of that august journal, the John O'Groat Journal. The headline reads "Ambulance crews: ‘Enough is enough'". It was a big story in Caithness. A gentleman by the name of Mr William McLeod, an ambulance technician who is based at Wick, is quoted frequently in the article. I will quote several pieces of his contribution. Mr McLeod said:
"Most of the crew members have revealed that they occasionally lose concentration, mostly when returning to Wick from Inverness after a call-out. Some have also developed a worrying habit of driving through villages and not realising that they have done so—a common symptom of tiredness and fatigue."
We have all done that—although I hope only once or twice in our lives—and we know how exceedingly dangerous that is. If someone's eyes start to close they might have a terrible accident.
Despite the fact that the Scottish Ambulance Service was given some £22 million by the Scottish Executive, that money was not used to make the partial out-of-hours coverage at the Wick ambulance depot a 24-hour service. That is the point of the debate and that is what I seek to probe the minister on. I would like to know whether the Executive can put pressure on the Scottish Ambulance Service to consider that possibility.
Of course the service costs money—there are currently 14 staff at Wick, working two shifts, and to put the station on 24-hour coverage would involve more staff and more costs. I lodged a question on the matter for the Minister for Health and Community Care at the end of last year. Speaking on the subject in the John O'Groat Journal, he said:
"The Scottish Executive has provided the Scottish Ambulance Service with an allocation of £108.783 million for 2002/03, an increase of 7.4% on last year.
This allocation supports the service's priorities of investment which include improving its operations room functions"
and so on. He also pointed out that the ambulance stations in Fraserburgh, Dunoon and Stranraer have been put on 24-hour coverage. I imagine that the Deputy Minister for Health and Community Care will come back with something similar this evening.
The population of Caithness is quite sizeable by Highland standards—a good number of people live in Wick and Thurso. The ambulance station in Dingwall, the county town of Ross and Cromarty, which is very close to Inverness, is on 24-hour coverage, and the mileage that ambulances have to cover to run people to Raigmore hospital is not great. Despite that, the station in Wick is not covered 24 hours a day. That is despite the fact that the distance from Wick to the main hospital in Inverness—Raigmore hospital, which covers virtually all the Highlands—is much greater. Therefore, because of the greater distance between Wick and Raigmore as compared with that between Dingwall and Raigmore, the community of Caithness is disadvantaged.
The Wick ambulancemen are suffering from sleep deprivation. They are endangering their lives and those of patients, and the 87p per hour rate for out-of-hours cover beyond their shift seems to me to be derisory. I do not know how people can have normal quality social life when they have to work under such conditions. The Wick station should go on to 24-hour coverage. That will, I admit, require more staff and mean more costs, but the Scottish Ambulance Service should address the situation.
Mr William McLeod says that in the past 25 years—ever since he joined the service—he has pushed for that change but has got nowhere. That is what has prompted the staff of Wick ambulance service to adopt such a high profile. Mr McLeod says:
"I have been working 25 years with the Scottish Ambulance Service. When I started the job we were told that the service and the unions were looking for elimination of stand-by but 25 years on we are still at the same spot."
Ambulance crews say, "Enough is enough."
I conclude with the following thoughts. Health care is for all, regardless of where in Scotland people live. Road safety is for all, regardless of where people live. For a community to be disadvantaged simply because it is far from Inverness—Wick, rather than Dingwall—is fundamentally unjust. I know that the minister and her colleagues in the Executive do their best to invest real funds—there has been a 7.4 per cent increase—in the Scottish Ambulance Service. However, on this issue it is the old story to which I have referred before. Despite the good intentions of ministers and the Executive, sometimes we do not see delivery at the other end of the delivery mechanism.
I thank colleagues for listening to me on this serious issue. I seem always to be fighting on health fronts in the far north; if not on Thurso accident and emergency services, Wick maternity services or GPs in Helmsdale, I am doing so on behalf of Wick ambulance service. I am grateful for the opportunity to share my problem with members and I look forward to hearing the other speeches; I am sure that members will have similar tales to tell from their parts of the country. I look forward to the minister's response and hope that she can be as helpful as possible.
I congratulate Jamie Stone on securing the debate on this important issue for his constituency.
As Jamie Stone said, there was when I was elected a similar situation in Fraserburgh. Until recently, Fraserburgh and Peterhead were the two busiest part-time ambulance stations in Scotland. I am delighted that after a long campaign—started by Alex Salmond and supported by local councillors—Fraserburgh became a 24-hour station in December. Peterhead will be upgraded in the coming year. I look forward to visiting Fraserburgh station shortly.
There is absolutely no doubt about the commitment of staff in the Scottish Ambulance Service to doing a quality job. The throughput of work that the Fraserburgh service handles has doubled in 10 years and its staff must be given huge credit for handling that work load professionally and in an exemplary manner, even though Fraserburgh was a part-time station. While I have the minister's attention, I hope that she will tell me when Peterhead will become a 24-hour station. The commitment has been made, but the timetable has not yet been set.
Jamie Stone made an important point about the remoteness of Wick and the distances involved for the ambulance staff who work there. I have to drive only 171 miles to get home tonight; I am afraid that I cannot beat Jamie Stone on that. I drive 40,000 miles a year, so we might trade numbers on the subject later.
Although Peterhead and Fraserburgh were undoubtedly the busiest part-time stations in Scotland, it is probably important that the metrics dealt with the number of calls. The minister might care to consider that if Wick does not necessarily get as far up the list as Fraserburgh and Peterhead, the quality of calls that are attended to there might give Jamie Stone the right to make a special pleading for the staff. The distances that are involved for Wick staff are quite ferocious; I am sure that Jamie Stone has many cases from his files to which he can refer.
We must consider public service and the health and safety of ambulance staff. It is vital that we do not place staff in the position of working an arduous shift, then being on standby to work, in effect, another shift in areas such as those that are served by Wick, only for them to have to go to work again the following day. That makes Jamie Stone's point particularly relevant and important.
We cannot allow such situations to continue, either for the staff or for the people who live in the areas that part-time ambulance stations serve. Accidents can happen at any time of the day or night. In the far north, the nights in winter are especially long.
I wish Jamie Stone well in his campaign on behalf of his constituents in the far north. I take great pleasure in looking out over the 65 miles to Wick across the Moray firth. I hope that he has as much success with his campaign in Wick as I have been able to achieve in Fraserburgh. Well done, Jamie.
I congratulate Jamie Stone on highlighting the ambulance service in this way, because the service is of the utmost importance to people's lives. In a perfect world, there would be 24-hour rostered working covering all of the Highlands and the Western Isles. However, such expense might not be within the Scottish Executive's budget. In the Highlands, only Dingwall and Inverness stations are full time at present.
I sympathise deeply with any ambulance crew that is sent out on a long-distance transplacement during call hours, when they have just worked a long roster shift of eight or 12 hours. When I spoke to the manager in Inverness, he highlighted that point and said that everything possible is done to avoid such situations, but they are unpredictable and occur only occasionally.
The nature of ambulance crews' work is that when they are on call, being paid only 90p per hour, they must be immediately reachable; there needs to be a three-minute response time. British Telecom workers, some of whom work along the same sort of lines, have to be reached only within about an hour. That is why any Wick ambulance crew must live within three miles of Wick. Crew members must also notify the Scottish Ambulance Service of any secondary employment that they undertake, and have it approved. Ambulance crews sacrifice a lot. Their job is very important and is undertaken only by individuals who have a vocation for it, because the job most certainly has its drawbacks.
Jamie Stone is asking for an upgrade to full-time cover for Wick. Again, although I sympathise with that, other areas will, I presume, also seek upgrades; for example Thurso, Golspie, Lairg, Lochinver, Kinlochbervie and Bettyhill, all of which have ambulance crews. The ambulance crews in those places surely feel that they, too, deserve more rostered hours. Stewart Stevenson mentioned Peterhead, which has a larger population than Wick and still works part time, but which would, I presume, make a similar call.
One other point that has been put to me is that if Wick station is made full time, it might be necessary to shorten the hours or reduce the crews to keep within the budget, which might weaken the service. At the moment, when on call the crews receive only 90p per hour, but once on a mission they move to the full-time rate. Some ambulance crews do not mind working like that, but others would prefer full-time rostered employment.
The situation calls for constant review of each station, because the Scottish Ambulance Service is a publicly funded body that provides a service that is based on patient demand. The service has come a long way since the days pre-1995, when many small stations were worked by contractors. Now, the staff are better trained and generally work in pairs. Wick has performed brilliantly, and is ahead of all its targets.
Finally, centralisation of health services is increasing the distances that are travelled by ambulance. For example, Caithness to Raigmore is a 200-mile round trip. Such a journey can be made longer by the need to pick up patients from different addresses in Caithness and Sutherland on the way south, by delays at Raigmore hospital, and by the delivery of patients to different addresses on the return journey. I sympathise very much with the ambulance crews, and I agree that people who live in remote areas should have the best of health care, but centralisation is working against that. More emphasis should be placed on upgrading the use of community hospitals which, in turn, would reduce the length of many ambulance journeys.
I am thankful for the opportunity to take part in this debate and I thank Jamie Stone for bringing it before Parliament.
Much of what Jamie Stone has told members applies to my constituency, which has the same sort of terrain and ambulance provision. It is generally accepted that ambulance crews are a vital front-line service. Like those in the fire service, for whom support has been expressed recently, ambulance crews do a difficult and sometimes dangerous job. I suggest that the current on-call working regime for ambulance crews should be reviewed because, as Jamie told us, the crews can be on duty for up to 20 hours, they receive little recompense and they are required frequently to make long journeys at the end of their shifts.
The ambulance service is an excellent front-line service. Its staff are trained to a very high standard and they do an excellent job, but they cannot be everywhere all the time. When an ambulance team has to respond to a call-out, that creates a problem for the neighbouring depot. If a unit is taken away from one depot, it must be replaced in case there is an emergency. If there is much demand on the ambulance service in such areas, the situation spirals out of control very easily.
After years of consultation and debate in the medical profession and the ambulance service, the provision that the local hospital in my area—the MacKinnon memorial hospital on Skye—is able to give the public has been reduced. There is little surgical provision there. I heard recently that a study costing about £100,000 had been commissioned to examine the surgical provision up and down the west coast. That study has come up with the brilliant idea that the Belford hospital in Fort William should not provide surgical services and that such provision should move to Oban's Lorne and Islands District general hospital in Argyllshire. It is understandable that that proposal does not please many people in the Fort William and Lochaber area. It is particularly unsatisfactory for my constituents, because the Belford hospital attends to their surgical provision.
An argument has developed about where that surgical provision should be provided in future. Staff at the Belford hospital suggest that all such work should be done in Fort William, rather than in Oban. The hospital in Oban has put forward arguments for doing the work there. Whatever happens, surgical provision will be diminished. That will require more ambulances and more travel.
The distance between the MacKinnon memorial hospital and the Belford in Fort William is about 100 miles, whereas the distance from the MacKinnon memorial hospital to Oban is about 140 miles. Driving conditions are not always good because the roads are very twisting and tortuous. That is not good for the ambulance or, more important, the patient. We should remember that the patients as well as the ambulance crews have to travel on those roads.
There is a helicopter service, but it is not always available—for example, it will be away on call in an emergency. In addition, the helicopter does not always fly at night or in adverse weather conditions. A pregnant mother who was being airlifted from a remote area of Skye to Raigmore in Inverness decided that she was going to produce her child in the middle of the flight. Because there was no room in the helicopter's cabin to attend to the lady, the helicopter had to land on one of the highest mountains in Ross-shire and the poor mother had to deliver the child at the top of a mountainous peak in Wester Ross. That is the sort of situation that arises.
We must give the issue careful and serious consideration and we must ensure that we can provide an ambulance service that has, at all times, an active and alert crew. Such provision is necessary not only for the benefit of the crew, but for the benefit of the patients to whom they attend.
I have two initial points, one of consensus and one of discord. I join other members in welcoming the debate and congratulating Jamie Stone on securing it, but I ask the Presiding Officer to reflect on the fact that not a single Labour member is present, apart from the minister. We are delighted to have her here, but in view of the massed ranks that could have been in the chamber, I make the point that members' business debates matter, and it would be courteous for parties to take that into consideration and ensure that they are properly staffed so that we can have a full debate. Perhaps that is something that the Presiding Officer could discuss with the business managers. We could have expected some members to show.
We are all in broad agreement about this evening's debate. There are two issues: the first is that of working practices; the second is the nature of the terrain that we are talking about. I associate myself with Jamie Stone's remarks and the examples he gave of the long hours and the distances involved in the job of the ambulance service in Wick and throughout the north-west division. The job is astonishingly difficult and we are right to give credit to the people who do it.
Evidence from the ambulance service gives the average weekly working time of people in the north-west division as 84 hours a week. That is in excess of the European Union working time directive. I am keen for the minister to tell me the Executive's view of that breach of the EU working time directive. What immediate remedial action can we expect?
On the argument about whether there should be an upgrade from part-time to full-time, I support Jamie Stone's call for the move to full-time cover—I believe that most members would. I would welcome it if the minister could clarify what criteria we are using. In his contribution, Stewart Stevenson referred to the fact that one factor is the number of calls, but presumably there is also the question of population. Will the minister give members a fuller understanding of what criteria Wick would have to meet before we could move to a fuller service in that area?
There is another factor that relates to the nature of the area—the seasonal swelling in the population due to the increase in tourist numbers. In the north-west division, it is estimated that the population increases from 240,000 to a figure three times as high at the height of the tourist season. Given the increased burden on the service, is that one of the factors that the Executive takes into account? If it is, what weighting is it given? It strikes me that if there is a part-time service in an area where there is population displacement, there should be a similar movement of service provision. I would welcome information from the Executive as to whether that is taken into account.
The issue is important and we are right to debate it. We are not discussing an ancillary or add-on service; it is a vital core activity. If the Parliament and the Executive are to take it seriously, the terms of the motion are a good place to start.
I welcome Jamie Stone's motion and am pleased to be able to take the opportunity to discuss the ambulance service, particularly in relation to the Wick area. If members will bear with me, I will make some general comments about how the ambulance service in Scotland has been developed during recent years.
In response to Duncan Hamilton's statement about members' attendance, I say that the member knows that members' business debates are often fairly thinly attended because of the nature of members' other business. I am sure that members who are interested will look to the Official Report of the debate and will take an interest.
I wonder about Duncan Hamilton's position. Only eight SNP members turned up to vote through stage 3 of the Criminal Justice (Scotland) Bill just over a week ago. People should get their priorities in order.
Will the minister take an intervention?
I will not give way to the member just yet. I may do so later, if I have time, but I have a lot of points to respond to.
As the first session of the new Parliament draws to a close, it is fitting to reflect on an excellent example of how the Parliament has shaped services for the benefit of the people of Scotland. Towards the end of 1999, the Comptroller and Auditor General reported in "The Scottish Ambulance Service: A Service for Life" on the efficiency and effectiveness of emergency ambulance services throughout Scotland. That report in turn informed the first substantive piece of work conducted by the Audit Committee of the new Parliament. Both the Comptroller and the Audit Committee commented favourably on the benefits to Scotland of having one national ambulance service. Management and support costs were minimised and having a national service provided for consistency of operational practice.
The Audit Committee sent a clear steer to the Executive and the service about the need to consider whether to introduce a system of priority-based dispatch as a means of supporting and improving the responsiveness of the emergency service, about how the control room function was provided throughout Scotland and how best to improve it, and about how to remove the variations in performance in different parts of Scotland and to bring the standard of the poorest up to that of the best. It also sent a clear steer on the need to consider how to reduce the overall time spent by ambulances in dealing with incidents and how to develop clinical performance targets and indicators and improved patient care information that would support the monitoring of the health gain achieved from the additional investment.
The service and the Executive supported all the substantive recommendations of the Audit Committee. The Executive has funded them all, and they are now being rolled out throughout Scotland.
The service's budget allocation for 2003-04 is now £119.7 million. All that will be invested in the employment and training of around 200 extra front-line emergency ambulance staff. The service has also developed a range of clinical performance indicators that will enable it to begin to measure whether the faster response times lead to an improved outcome for patients.
Implementation of the improvements to the control rooms began last August in NHS Lothian, followed by the roll-out of priority-based dispatch. Positive progress is being made on the clinical outcome indicators, although further work needs to be done to ensure that the patient experience and outcomes through admission to discharge from hospital are tracked and recorded.
I turn to the situation in our remote and rural areas. The provision of health services in remote and rural parts of Scotland presents challenges that are very different from those in our more populated areas. Difficulties in areas such as recruitment and retention are often magnified in isolated communities. The Executive is committed to providing investment and support in those areas and to tackling the issues affecting them. That is demonstrated by a number of major initiatives to provide additional investment to modernise the infrastructure through improved premises, information technology and transport links, to speed up communications, and to cut the need for patients to make long journeys, partly through the use of telemedicine. The Executive is also committed to attracting health professionals to remote areas through a number of recruitment and retention measures.
Some of the additional resources that the Executive has put into the ambulance service have been used to support the conversion of a number of ambulance stations to full-time working practices. The demands on all 152 ambulance stations in Scotland, particularly the 100 that serve remote and rural areas, are the subject of continuing monitoring and review by service management. Because of that review, this year we are able to move stations in Stranraer, Dundee and Fraserburgh into the full-time category. Stewart Stevenson referred to the situation in Peterhead, which is one of the number of stations that are programmed to move to full time—I do not have an exact date at the moment, but when I do I will let Mr Stevenson know.
I hear what the minister is saying about upgrading, and I agree with that. Wick has Caithness general hospital, yet trips have to be made all the time to Raigmore. Would it not be better to upgrade the hospital, rather than having to upgrade ambulance services continually?
Almost all the out-of-hours calls are dealt with locally in Wick. Transfers are the exception, not the rule. We must see the picture as it is.
In addition to performing continuing reviews of demands on ambulance stations, staff and managers in the Highlands operate a system under which any incidence of excessive working hours is identified immediately and staff are stood down until they are fit to resume duty. Managers who cover the Highlands have received no reports that any member of staff has worked 20 hours or more in a 24-hour period. Since last August, only eight out-of-hours transfers of patients from the Wick area have been undertaken, all of which were to hospitals in Inverness. Only twice were staff asked to stand down before completing their shifts. Those incidents were the result of cases in the early hours, and the numbers of hours that were worked in the 24-hour periods were eight hours and 55 minutes and 13 hours and 41 minutes. The situation is rare, but when it happens, action is taken. In the past four months, no out-of-hours transfers have occurred in the Wick area, and in the previous four months, only two transfers took place.
The Scottish Ambulance Service has worked closely with the Health and Safety Executive to ensure compliance with the European working time directive, which Duncan Hamilton described. No breaches of the directive have been recorded.
I hope that members accept that the Executive is committed to a Scottish Ambulance Service that is responsive to the needs of all in our population, wherever they may be—even in our remote and rural areas. People in those areas deserve the service as much as anybody else does and we are working to ensure that they have it.
Meeting closed at 17:36.