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Ambulance Service (Scotland)

Volume 14: debated on Monday 30 November 1981

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Motion made, and Question proposed, That this House do now adjourn.—[ Mr. Budgen.]

10 pm

This being St. Andrew's Day, it is appropriate that we should finish our business with a Scottish subject. I commence by expressing the hope that the Minister will give a considerably better reply to this short debate than his hon. Friend the Financial Secretary gave to the debate on the Comptroller and Auditor General.

I congratulate the Minister on his recent appointment to an important position in the Scottish Office. I hope that it will be a brief prelude to a long and happy career as Opposition spokesman on Scottish health and social service affairs.

Is my hon. Friend aware that there was no answer at all by the Financial Secretary to the doctrine of Government irresponsibility on finance?

I noticed that.

I want to draw the attention of the House to the Scottish ambulance service and some of its problems. One of the main problems facing the service and the NHS in general is that some prominent Conservatives are hostile to the whole concept of the NHS. Any restriction in the necessary growth of the NHS may encourage private medicine and the privileged few who benefit from it, but it will harm the NHS and take us one step nearer to the American situation where ambulance men are said to check how wealthy casualties are before they offer assistance.

In Scotland, as elsewhere, the ambulance service is an emergency service first and foremost. It is available 24 hours a day to attend anyone taken ill or involved in an accident, to provide first aid and to transport patients to hospital. The service also does vital work in transporting non-emergency patients between their homes, hospitals and day centres. I am reliably informed that the split between emergency and routine work is about 50–50, which indicates that the burden of emergency responsibility is slightly heavier than that of the other emergency services in the fire brigade and police force.

That is confirmed by a recent analysis of emergency-999 calls, which showed that the overwhelming majority of such calls are for the ambulance service. It follows that there can be no question but that the Scottish ambulance service is an extremely important part of our vital emergency services, and it is scandalous that the Government's pay negotiators have tried to argue from time to time that it is not.

The continuing classification of ambulance men as manual workers is an insult that does not make sense. Most people in Scotland regard the ambulance service as at least as important as either the fire brigade or the police force, because ambulance men co-operate with firemen, policemen, coastguards and lifeboat men, doctors and nurses to save lives at times of danger. There can be nothing more important or essential than that.

In view of that simple consideration, it is astonishing that a fully qualified ambulance man, trained to save life in difficult circumstances, is classified as a manual worker and works for a basic wage of only £82·54 a week, while a similarly qualified fireman earns more than half as much again—£139·18—and an equivalent grade in the police force gets £170, more than double the ambulance man's basic wage. Similar differentials apply between the other grades in these three services, but I understand that an earnings disparity puts Scottish ambulance men on an even worse footing than their English and Welsh counterparts.

This discrepancy in pay between equally vital services is inexplicable and inexcusable. It appears to be getting worse. I understand that during the most recent pay negotiations the ambulance service got 7·5 per cent. ; the fire service, 10·1 per cent. ; and the police force, 13·2 per cent. The ambulance service is becoming increasingly worse off.

In the circumstances, it is hardly surprising that morale in the Scottish ambulance service is low and that in some quarters there is talk of militancy. Scotland's ambulance men do not wish to do the unthinkable. They do not wish to take industrial action that would endanger the very people whom they wish to serve, but they are becoming increasingly exasperated by the Government's failure to recognise their special dedication, skill and training by paying an appropriate rate for the job.

I have been impressed and concerned by the strength of feeling expressed about pay at lobbies of the House by Scottish ambulance men and when I visited the largest ambulance station in my constituency at Haddington. I have also been impressed by the dedication of ambulance men and the equipment that they have at their disposal, although I make a passing reference to continuing doubts about the safety of the wheels on some of the Bedford vehicles still in service in Scotland.

One matter that alarmed me seriously on my visit to Haddington was the undermanning of ambulances in rural areas. I wish to refer in detail to my constituency, because it is the rural area of Scotland about which I know most. In Berwickshire and East Lothian there are 15 ambulances based at eight points throughout the counties. The number of vehicles is probably adequate. The problem is that each ambulance is usually manned by only one ambulance man at any given time. In urban areas of Scotland and in Northumbria—just over the border from my constituency and also a rural area—ambulances are properly manned with two trained men when they are out on service. The Scottish ambulance training course is based on the optimistic assumption that ambulance men will work in pairs.

When new trainees find employment at rural ambulance stations in Scotland, they must learn again how to do two jobs at once. Therefore, at an early stage, they must break many of their own rules. At an incident where there are two or more casualties, one of the ambulance men attending is supposed to remain in constant radio contact with his control centre. That is impossible when there is only one ambulance man, because he has many other things to do at the same time. He is alone. When attending such an incident—for example, a car crash—our lone ambulance man must assess the position, render first aid and report back to base.

That is not the end of his problems. He must then get the patient into the ambulance. That may be a complicated matter if he has to carry an elderly person downstairs. Even when he gets down to ground level, unless he receives some assistance, he must carry both ends of the stretcher at once, which is clearly physically impossible. Therefore, he must try to get a passer-by to assist him.

Finally, when the patient is in the ambulance, the ambulance man is responsible for using the life-saving equipment in the back of the ambulance and for driving the vehicle to hospital at the same time. Such situations call for bionic ambulance men. Although they are clever and dedicated people, that is plainly impossible.

In an attempt to overcome the problem, small mobile attendant vehicles have been introduced in the Scottish ambulance service. There are two in my constituency: one in Berwickshire and one in East Lothian. In theory, the attendants are supposed to speed from incident to incident to assist individual ambulance men on the spot. In practice, that is often impossible because the attendant can be busy—in my constituency up to 30 miles away—dealing with another incident.

I am indebted to my constituent, Mr. Robert Cranston, of Haddington ambulance station, who is branch secretary of NUPE in the area, for letting me see a detailed record of emergency incidents in East Lothian during the eight months from January to August 1981. The record shows no fewer than 72 incidents where the mobile attendant vehicle was required but was not immediately available. In 10 of the incidents it took between 10 and 35 minutes for the attendant van to arrive at the scene. At least in those cases the attendant van arrived. In the remaining 62 cases it was not available at all, and the ambulance man was left to his own devices, had to call another ambulance or rely on assistance from the police and the public. In other words, once in every four days, an ambulance man somewhere in East Lothian has to cope single-handed with a potential life or death crisis. The same applies throughout Scotland in all the areas outside the major cities.

For example, on 28 December 1980, at 6.30 pm, the ambulance from Haddington was called to an incident on the A1 at Birsley Brae, near Tranent. There were six casualties. Clearly one ambulance man could not cope. He called for assistance, but the attendant van was tied up in Edinburgh. Two more ambulances had to be dispatched from Dalkeith. As there were severe injuries, one ambulance man had to remain with the patient in the back of an ambulance and his own ambulance, which might have been urgently needed elsewhere in the area, had to remain locked at the roadside because there were not enough staff.

On 22 April an ambulance was called to a casualty at Ormiston. The attendant van was busy 15 miles away at Dirleton and the ambulance man had to cope alone. On 8 August an ambulance was called to a motor accident on the Al at Cockburnspath where there were two casualties. The mobile attendant van was tied up at North Berwick. Another ambulance had to travel 15 miles from Eyemouth in Berwickshire to assist.

Those are three examples in an eight-month period of the 72 crises that resulted from the undermanning of ambulances in East Lothian.

There have been occasions when a policeman, not familiar with the vehicle, has had to drive an ambulance to hospital in Edinburgh while the ambulance man kept his patient alive in the back of the van. I hope that I have shown that ambulances in rural Scotland are dangerously undermanned. That is absurd at a time when hundreds of suitable and willing potential recruits are wasting their time on the dole. I hope that I have also shown that ambulance men throughout the United Kingdom are seriously underpaid for their crucially responsible work.

I pay tribute to all the emergency services in Scotland. I wish to express the deep gratitude that all Scots feel for the work that they do 24 hours a day. I hope that the Minister will take the opportunity to recognise the value of our ambulance men by announcing a significant and immediate increase in ambulance staff in rural Scotland because of the serious position that I have described. I hope that he will also take the opportunity to say that the Government accept that the ambulance service is a first-line emergency service that should be funded accordingly through the Common Services Agency. I fear that if the Minister fails to give a satisfactory reply to those two simple requests he will cause great disappointment and bitterness in the ambulance service in Scotland. I am sure that he is well aware of the heavy responsibility that he carries in that respect.

10.14 pm

I am grateful to the hon. Member for Berwick and East Lothian (Mr. Home Robertson) for his personal remarks. It is perhaps particularly appropriate that I was born in St. Andrew's and reply to my first Adjournment debate reply on St. Andrew's Day.

The House will be grateful to the hon. Gentleman for raising the subject of the Scottish ambulance service. It is an important subject. The hon. Gentleman has made some important points. I was sorry that he had to spoil a generally well-informed speech by a party political jibe at the beginning. I feel obliged to tell him that in Scotland this year the National Health Service will receive in real terms more in resources than in any year of the Labour Government.

First, I pick up the hon. Gentleman's final theme. I agree with him in paying tribute to the Scottish ambulance service and all its members for the invaluable contribution that they make to the Scottish Health Service and to the community at large. I shall return to this theme, which the hon. Gentleman mentioned more than once in his speech.

The ambulance men have been concerned recently about the value that the community generally attaches to their important work. I assure them and the hon. Gentleman that the Government fully recognise the essential part that ambulance men play, together with doctors and nurses, in providing emergency services for the sick and the injured throughout Scotland. That is in the highest tradition of public service, and Scottish ambulance men have every right to feel proud of the way in which they carry out their duties.

The second underlying theme in the hon. Gentleman's speech was the need to ensure that the important work of ambulance men is properly rewarded. I accept that the Government have a duty in that respect. We also have a duty to ensure that other groups of Health Service employees are suitably rewarded for the work that they do. Beyond that, of course, we must have regard to the wider economic well-being of the nation as a whole, and that obliges us to set a limit to the resources that can be made available to any part of the public services. However, as I have stressed, we have been talking in Scotland about increased real resources for the National Health Service.

Recent pay increases for ambulance men have had to be contained within an overall increase of 6 per cent. and in this respect they have been treated no differently from the vast majority of other public sector workers.

When we look back at recent events, I am sure that we all very much regret the fact that the ambulance men felt obliged to withdraw their services during pay negotiations. That threw additional strain upon other public sector workers and inevitably caused serious anxieties to the public at large, particularly to those who had need of those services.

I should like to deal with the hon. Gentleman's point about comparisons between the work of the ambulance service and that of the police and fire services. Claims have been made that all three services should be placed on an equal footing in respect of remuneration. It is true that the Clegg report, which was not a Conservative-inspired document, said clearly in 1979 that the duties of ambulance men were not directly comparable with those of the police or of firemen. It would be more reasonable to regard the ambulance service as an extension of the National Health Service than to compare it directly with the police and fire services.

Ambulance men are part of a total health care team that also includes doctors and nurses. Therefore, the ambulance service is an integral part of the accident and emergency services of the National Health Service. The range of work that ambulance men have to undertake as members of such teams extends, as the hon. Gentleman rightly said, from the routine conveyance of patients to day hospitals and out-patient clinics, to emergency work of the highest urgency in situations of life and death. I am sorry, but I must disagree with the hon. Gentleman's figures. I am informed that the latter category of work—the real "flashing-light" emergencies—represents less than 20 per cent. of the total workload of the Scottish ambulance service. It is important to recognise that fact when comparisons are made between the ambulance men and the policemen and firemen.

I continue on the general theme of pay and conditions for ambulance men. They are determined on a Great Britain basis and are dealt with by the ambulance men's Whitley Council, which is different from the structures for dealing with manual workers in the National Health Service. That body represents the management and staff, and negotiations on pay and related conditions of service are primarily matters for it, although the Government must pay due regard to what the country can afford in increases in remuneration to public servants.

The hon. Gentleman spoke about the earnings of Scottish ambulance men in relation to those of ambulance men in England and Wales. I stress that in England and Wales there are no relief staff to cover holidays and absences due to illness. Therefore, crews in England have considerable opportunities to earn overtime, which are not available in Scotland because the Scottish ambulance service has 101 relief staff, so there is inevitably less overtime. That is the major reason for the difference in earnings.

Here, I should like to make a constructive point, which I hope will be met constructively, about the future of pay in the ambulance service. At present, ambulance men are paid a basic weekly wage, supplemented by various payments for overtime, shift work, weekend work, and other pay elements. Those rates of pay inevitably vary in different parts of the country. It is a reasonable suggestion that consideration should be given to the possibility of introducing a composite salary that consolidates, as far as possible, pay and various allowances. That would achieve some equality of remuneration for ambulance men over the whole country, and the suggestion is currently being carefully investigated by the Whitley Council.

I should he grateful if the Minister would say another word on the question of comparability between the remuneration of the various emergency services. He conveniently skated round that point. Surely he must accept that both the ambulance men and the public whom they serve regard the ambulance service as an essential, integral part of our first-line emergency services? Is it not therefore extraordinary that the ambulance men should be paid so much less than policemen and firemen? Will the Minister take this opportunity to express a hope or an intention that in future the differential can be closed up a little?

I am glad to respond to the hon. Gentleman's second speech. I have made it very clear that I regard the ambulance service as an integral part of the emergency services of the National Health Service. However, one must bear in mind the comments of the Edmund-Davies and Clegg reports. I agree with the hon. Gentleman that the ambulance service is an integral part of the emergency cover provided by the NHS and by doctors and nurses, who also carry out emergency work.

I should like to deal with the important constituency point raised by the hon. Gentleman in relation to double manning.

I shall deal with undermanning in about one and a half minutes. First, I shall deal with double manning. The Scottish ambulance service operates a fleet of about 850 vehicles, all of which are equipped to deal with the full range of duties that may have to be carried out, from the emergency conveyance of patients injured in accidents to the transport of individuals to day hospitals and clinics.

The ambulance service has little control over the demands that are placed upon it. It is dependent upon events. Therefore, it must try to reach the optimum level of performance. In the urban areas, where demand is greater, most ambulances have two-man crews, but in rural areas, where the demand is lower it is necessary to station vehicles at strategic points outside the main depots. It is economical to have some ambulances that have only a one-man crew.

The service has to try to achieve a balance between an ideal level of manning that would place heavy demands upon resources and a method of working that achieves a satisfactory degree of cover at reasonable cost. The service has tried to reconcile these two aims by operating a number of procedures that are designed to provide certain ambulances with a two-man crew where this is felt to be necessary. Accordingly, in some ambulance stations, ambulances with a one-man crew are backed up by mobile attendants who can be deployed through the ambulance headquarters to support a one-man ambulance whenever necessary. That is the situation that the hon. Gentleman has described in his constituency.

The Scottish ambulance service is continuing to extend arrangements for double manning as resources permit. Its aim is to ensure that a two-man vehicle is always available for emergency cover in nearly every part of Scotland. There has been a 50 per cent. increase in ambulance personnel since 1974.

I turn now to the hon. Gentleman's constituency arguments. As he has said, there are two main ambulance depots, one at Haddington and the other at Duns. Both provide full 24-hour cover. Although each vehicle has only a one-man crew, a mobile attendant is available at all times so that a vehicle with a two-man crew can be provided whenever that is necessary. Ambulance cover in the East Lothian area is supplemented by vehicles stationed at Ormiston, Dunbar and North Berwick, which can be called out at any time during the 24 hours if required. In Berwickshire there is a standby station at Eyemouth.

The hon. Gentleman referred to the adequacy of the cover provided by these arrangements. In a recent three-month period my figures reveal that the Haddington station received a total of 117 emergency calls. I understand that in 81 of these calls the ambulance was at the scene of the incident within 14 minutes and that in 32 calls it was there within 20 minutes. There was a similar pattern at the Duns station.

The Scottish ambulance service has studied the emergency calls made to the Haddington station from May to October. I regret to say that my figures appear not to be completely compatible with those that the hon. Gentleman has provided. Over the six months there were 219 emergency 999 calls. On 39 occasions the mobile attendant was already committed, but on every occasion there were other crewmen available if necessary. I think that these figures represent a satisfactory performance by the ambulance men stationed in the hon. Gentleman's constituency. The hon. Gentleman has referred to specific incidents. If he wishes to confirm them in writing to me, they will be investigated.

It is important to stress that only about 20 per cent. of the total work load of the service is related to accident and emergency calls. By far the majority of the work is of a fairly routine nature. It is not any the less important for that. The community owes a large debt to the ambulance men in Scotland and to those who manage this important service for the valuable contribution that they make to the life of our country. The Government will continue to ensure that the necessary resources are made available.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes past Ten o'clock.