Motion made, and Question proposed, That this House do now adjourn.—[Mr. Alan Campbell.]
Order. The next business is the Adjournment debate, which is very important. Will hon. Members please leave quickly and quietly so that we can get on with that important business?
Thank you, Mr. Deputy Speaker.
I am grateful for the opportunity to convey to the Minister the concerns of my constituents about the proposed reorganisation of the ambulance service in Teesdale by the North East ambulance service. Let me begin by describing, very briefly, the area affected.
Teesdale is in the western part of my constituency, and measures 325 square miles. The valley consisting of several villages west of Barnard Castle has some 10,000 inhabitants, and 29 per cent. of the population are over the age of 65—twice the national average. The region is an area of outstanding natural beauty and attracts many tourists and other visitors, who unfortunately sometimes come to grief on the 200 miles of B and C roads. There are also four large trunk roads—the A66, the A67, the A68 and the A688—where serious accidents sometimes occur.
At present, there are two ambulance stations in the area, one in Middleton in Teesdale and one in Barnard Castle, with a total of seven staff working 12-hour shifts and then being on stand-by for 12 hours at night. They have to live within 3 miles of the station so that if they receive urgent calls, they can arrive in time. Under the current rules governing response times, 75 per cent. of life-threatening accidents—accidents in category A—must be reached within eight minutes, while 95 per cent. of category B accidents, involving serious injury, must be reached within 19 minutes. Category C accidents can involve alternative kinds of treatment, but category D requires “GP urgent” calls, and the GP will say what the time should be. Those rules were set by the NHS, and I am sure that the Minister is fully aware of them.
According to figures from Durham Dales primary care trust, more than 40 night-time emergency calls were received in Teesdale in 2005—the most recent year for which statistics are available—of which 95 per cent. fell into categories A or B, or were “urgent GP” calls. As local GPs have confirmed, that means that in most cases those affected needed hospital treatment. There were 7.5 per cent. more calls than in the previous year. Incidentally, that picture is very different from the national one, in which 70 per cent. of 999 ambulance calls do not fall into the very urgent categories.
As the Durham Dales PCT says, NEAS has consistently met national response times to save patients’ lives, and that has been recognised by the award of a three-star rating for the past four years. That is why people locally find it hard to understand why changes need to be made. In two respects, the situation in Teesdale is different from that in the other rural areas in the north-east, such as Weardale and Northumberland. First, Teesdale is more populous. One of the complaints local people have made is that the level of calls in Teesdale is higher than in Amble or Belford, which are not being reorganised in this way. Secondly, it has not been difficult to recruit staff, which was a problem in Weardale. I am concerned that NEAS, in its enthusiasm for efficient administration, has treated all the rural areas as homogenous, when they are of course quite different.
The original proposal from NEAS was to close the ambulance stations in Middleton in Teesdale and in Barnard Castle and replace them with single paramedics. That proposal was totally unacceptable, as the nearest hospitals are 30 to 40 minutes away in Bishop Auckland and Darlington, so the time taken to reach hospital would have been extended by 40 to 50 minutes, as the paramedics would first have had to attend and make an assessment. Moreover, the idea would not have met national guidelines. It provoked local people, including health professionals, those working in the service and the patient and public involvement forum. I have received a petition signed by 5,000 people, 3,620 of whom live in Teesdale—a third of the whole community affected. The petition makes it clear that they want a double-crewed paramedic ambulance 24 hours a day, seven days a week.
Following much work and activism by local people, NEAS has modified its proposal, but I am afraid that it is still putting forward a solution that appears at first sight to be worse than the current one. I shall therefore ask my hon. Friend for some clarifications and assurances. NEAS now proposes to close the Middleton in Teesdale station only. No reason has been given for that. My hon. Friend needs to understand that Middleton in Teesdale is some 12 miles from Barnard Castle. It takes half an hour to get to Middleton in Teesdale, and that time will be added to all journeys to the upper dale, including those to large road accidents on the A roads in the Pennines. Furthermore, it would probably be slower than having people on stand-by in Middleton in Teesdale. Would it be possible to retain the Middleton in Teesdale station? If not, why not?
As I have explained, the original proposal was that a paramedic would arrive on a motorbike and not be able to take a person to hospital straight away. Will my hon. Friend the Minister confirm whether, under the revised proposal, the paramedic will always arrive with an ambulance, which can take the person to hospital immediately, if necessary?
A third issue that staff have raised with me is the medical qualifications of the emergency care assistants who drive the ambulance, which will be less than those of existing ambulance staff. That does not seem to be very safe, especially for complex problems or where more than one person has been injured, say in a car accident. Surely that marks a worsening of the service and patient care. My understanding is that no job description has been agreed with the trade union, Unison, for the new care assistants. Is Teesdale being used as a guinea pig to test a new practice, in the hope that it can be rolled out nationally if the ambulance service thinks that it works well?
The latest document from the Durham Dales PCT makes much of the overall increase in staff numbers in the service. Incidentally, I would be interested to know why the new arrangements will leave Weardale and Teesdale with the same number of staff, when Teesdale has three times as many calls as Weardale. More fundamentally, the paper from Durham Dales PCT states that
“the Community Paramedics will take on a number of other roles in general practice and the wider community.”
That sounds like an ambulance driver cum health visitor cum district nurse role, but it would be helpful to know what proportion of time will be spent in each role. How will that fit in with other work? What would happen, for example, if a community paramedic was helping an old person with medication and an emergency call came in?
I have some questions about the funding implications in respect of the extra paramedics. Will the PCT, which ultimately pays for the service, have to cut other services to finance the proposals? Has extra money gone into the budget for this year and successive years to pay the additional staff costs?
My hon. Friend the Minister should be aware of the wider context of the proposal. First, the air ambulance service in the north of England is continuing to struggle financially. The NEAS says that it does not rely on the service, although it is invaluable, so can my hon. Friend tell the House how many times the service has been used in the area over the past two years? As I am sure she is aware, the air ambulance service relies entirely on voluntary donations—unlike Scotland, where it is state funded—and recently one of the helicopters was grounded due to shortage of funds.
Secondly, there is an interrelationship between the proposed reorganisation and the ending of the GP out-of-hours service in Teesdale, which is another local concern. Soon, there will be no GP service in the evenings or from early evening on Friday until Monday morning, which is 60 hours in total. As the nearest hospital is in Bishop Auckland, 20 miles away, it is highly likely that the ending of that service, coupled with the NEAS reorganisation, will further increase the number of ambulance calls. Has that possibility been taken into account in the proposals?
The most important thing is that the ambulance service retains the confidence of local people. Chapter 7 of the recent health White Paper, “Our health, our care, our say”, is headed “Ensuring our reforms put people in control” and states:
“People’s voices need to be heard and they have to count. This includes everyone, including groups such as children and young people who do not always have the choice to participate…Commissioning must be informed by people’s voices and be responsive. Local people must play a role in the planning, design and delivery of services.”
The people of Teesdale have spoken. I hope that they will be heard.
I congratulate my hon. Friend the Member for Bishop Auckland (Helen Goodman) on securing this debate and on expressing so eloquently her concerns and those of her constituents. I take this opportunity to pay tribute to all the NHS staff in County Durham and the Tees valley area who have made such great progress in improving the NHS. I am sure that my hon. Friend will join me in praising the work of NHS staff in helping to make some of the improvements in her local area. Some of the funding increases for PCTs in her area have contributed to more doctors and nurses and to cuts in waiting times in recent years. We all welcome that.
Real progress has been made in the health service in my hon. Friend’s area, but alongside record levels of investment, we must recognise that reform is certainly needed to deliver the NHS fit for purpose in the 21st century that we all want. It is vital that the local NHS can consult local people, and I shall set out some of the structures for doing that later in my speech. As my hon. Friend rightly said, it is important that the views of local people are taken into account. That is why many NHS organisations are looking, with local stakeholders, at changes in the organisation of their services. I am sure that my hon. Friend will agree that, as we see different roles emerge for staff and changes in technology, there is more that we can do to meet patients’ needs, and that it is important that we take those steps.
My hon. Friend asked a number of questions about the background to why changes are being made to the rural ambulance service in County Durham. In June 2005, the Department published the results of our national review of ambulance services—carried out in conjunction with staff—which examined some of the associated clinical issues and the changes that we wanted to make to services. That review set out how we can transform such services, moving them away from a focus primarily on resuscitation, trauma and acute care, and toward becoming a mobile health resource for the whole NHS that takes health care to patients in the community, rather than always transporting them to emergency care. We certainly support the review and we are considering how we can implement the recommendations.
As my hon. Friend said, her constituency is served by the North East Ambulance Service NHS Trust, which is made up of dedicated and hard-working staff. As a result of their dedication, increased investment and wide-ranging reform of working practices over the past six years, ambulance performance has improved, as my hon. Friend mentioned. The local ambulance service is now reaching more patients with life-threatening conditions faster than ever before. In 2004-05, the service responded to 77.4 per cent. of category A calls within eight minutes.
However, there is always scope for further improvement, and Durham Dales primary care trust, which commissions ambulance services in the area, has launched a 12-week public consultation exercise on proposals to modernise them. The trust’s vision is to provide an equitable emergency care service across the whole area. As my hon. Friend said, the PCT is currently serviced by three standby stations. Staff who have been on duty during the day at those stations are also expected to be available to respond to emergency calls and GP-urgent calls from their own homes at night. So at the moment, the crew are alerted by ambulance control at their homes, they get dressed, travel to the station, pick up the ambulance and respond to the incident. Inevitably, that results in delays, and response times are not always being achieved, due to that delayed action at night. Unfortunately, that can of course mean that patients do not always get the best service that we want to see, and the long hours that crews are required to work are detrimental to their health and well-being, as well as to the overall provision of service.
The new proposals represent £200,000 in additional investment in ambulance services, which is very important. My hon. Friend asked whether that will be to the detriment of other services, but we should consider the knock-on effects of a reduction in emergency admissions as a result of introducing a new service. It is important to provide that additional investment, and I hope that that gives my hon. Friend some reassurance.
Standby working practices will be replaced by 24-hours-a-day, seven-days-a-week cover for the communities in Durham Dales, which will ensure proper round-the-clock cover at all times. As my hon. Friend said, the current staff of 11 will be increased to 22 and will comprise 12 community paramedics and 10 emergency care assistants.
Each ambulance will be staffed by a two-person crew. There will be a highly qualified community paramedic who will be trained to respond quickly, assess and treat patients, and, if necessary, transport them to hospital. An emergency care assistant will be trained to the equivalent level of first aid responders and will also be qualified to drive an ambulance under blue light conditions. That was changed during the pre-consultation period to ensure that an ambulance with a two-person crew would be available at all call-outs. I hope that that addresses my hon. Friend’s point.
That is very much in keeping with the Department’s wish to transform the service nationally. That is some of the background. Community paramedics will differ from traditional ambulance crews in that they will work more closely with other health care professionals. For example, working alongside GPs, they will be trained to a higher skill level in areas that will best meet the clinical needs of the community that they are serving. For example, they will be able to treat patients in the community or in a surgery, carry out urgent home visits on behalf of a GP, and assist nurses with tasks such as taking blood, immunisations and monitoring heart rhythm. As a result of those changes, the local health service will be able to make sure that it is making the best use of resources, providing more convenient services from the patient’s point of view, and, of course, developing team working.
Coming back to the wider benefits, more patients being treated in the community will mean fewer unnecessary accident and emergency attendances, which is important when we think about a lot of our constituents, who might be taken to an accident and emergency department because they were not treated at home or in a GP’s surgery when they could have been. Once in hospital, it is much more difficult to get out. If we can prevent those unnecessary admissions, it is better for patients and better for the local NHS. However, responding to 999 calls will always be the priority. As is the case now, should there be a serious incident, the ambulance service will always deploy additional ambulances.
Two double-crew community paramedic ambulances will cover the Teesdale and Weardale areas. The two new bases in the Durham Dales will be for equipment storage and routine vehicle maintenance, replacing the three current stations. The two new ambulances bases would be in Stanhope to cover Weardale, to improve response times to emergency calls, and in Barnard Castle to serve the Teesdale area.
Ambulance cover in my hon. Friend’s area is provided across three stations, as she said: St. John’s Chapel, Middleton in Teesdale and Barnard Castle. I am aware of her concerns that these proposals would mean the closure of Middleton station, but it is important to note that Barnard Castle and Middleton in Teesdale currently operate as a single unit. As such, ambulance cover in Teesdale is based in Middleton for only one week in three. For the other two weeks, ambulance cover is provided from Barnard Castle.
Establishing the community paramedic base in Barnard Castle will formalise that shared rota arrangement. It means that there will be a greater number of staff and a higher quality of service. Barnard Castle has been indicated as the proposed site because its population is 5,326, which is several times larger than that of Middleton in Teesdale. The analysis of calls shows that there are twice as many calls from Barnard Castle as from Middleton. Barnard Castle is centrally located. It is important to stress that no final decisions have been taken and that none will be made until after the public consultation exercise. I will run through exactly how that is taking place a little later.
The existing system is slightly outdated for a modern ambulance service. Such a service needs to be responsive to the needs of patients and to improve the working lives of staff. We must consider whether the kind of stand-by arrangement about which we have talked really offers an acceptable work-life balance for ambulance staff. I understand that some staff in the stand-by stations approached the ambulance service to request a change to working practices. In addition, as my hon. Friend said, it is effectively a condition of employment at present that crews must live no more than 10 minutes away from the ambulance station. That can place restrictions on the recruitment pool that is available, and although that might not be a problem at the moment, it is important to think about the future. I understand that the PCT is keen to talk to local schools about recruitment to, and career prospects in, the ambulance service so that people continue to be encouraged to come forward.
I hope that I can assure my hon. Friend that the review is about achieving better response times. It shows a desire to do more for local communities and to work in partnership with primary care. It is not a cost-saving exercise, and there will be £200,000 of additional investment. My hon. Friend asked where some of the changes came from. The community paramedic concept certainly arose from to a desire to provide fast response times to life-threatening emergencies in rural areas. She asked about the national roll-out, and such a system has been introduced successfully in several other rural ambulance services. As I said, staff numbers will be increased from 11 to 22.
My hon. Friend asked about the air ambulance service. As she will know, it is funded by a charity, and it is not possible to give completely accurate figures. However, I believe that since the service commenced, it has attended about 8,000 incidents.
My hon. Friend talked about the importance of public consultation and the local voice being heard. It is important to remember that the NHS has a legal responsibility to promote public involvement and consultation under section 11 of the Health and Social Care Act 2001. I know that an extensive public engagement process took place from July to October 2005, which included public and council meetings at which patients and the public were given the opportunity to comment. Given what my hon. Friend said about the petition, people certainly seem to know about the proposals. The PCT and the ambulance service examined closely the views that had been expressed when it considered the proposal to replace the stand-by working practice with the new way of working. As I said, several changes were made to the proposals at the pre-consultation stage. For example, there will be crews of two persons, rather than one.
The public consultation that was launched last week will run until 18 September. When the consultation period has closed, the feedback will be considered by Durham Dales PCT, which will take into account the results of that consultation before making its final decision. I would really like to assure my hon. Friend. While she has obviously reflected some of the local concerns, it is important to remember that the consultation is guided by the attempt to improve services for patients while also seeking to improve the working lives of staff. It is important that the extra investment is accompanied by the sort of modernisation that we have talked about.
At the end of the day, what is important is saving people’s lives. If we can secure a system that achieves that while at the same time encouraging people to join the ambulance service and to feel that they have a good career structure within it, that is the way to proceed. I know that my hon. Friend has engaged with the local NHS on the way forward and I encourage her to continue to do so. I know that she will reflect her constituents’ views during the consultation period and I hope that, in the end, we arrive at a system that improves patient services as well as the working lives of staff.
Question put and agreed to.
Adjourned accordingly at one minute past Eight o’clock.
The House divided: