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Staffordshire Ambulance Service

Volume 454: debated on Tuesday 5 December 2006

It is a pleasure—in some ways—to be here, and a pleasure, too, to see so many Staffordshire Members of Parliament present. I bring apologies from my hon. Friend the Member for South Staffordshire (Sir Patrick Cormack), who had to be abroad on parliamentary business today.

We have all heard of a postcode lottery in the national health service. Until recently, we in Staffordshire have been the beneficiary of that lottery. We have the best ambulance service in Europe, and until now, a person was four-and-a-half times more likely to survive a severe heart attack in Staffordshire than in the west midlands. Why? Staffordshire ambulance service crews and community first responders arrive quickly to attend to victims, and until now, they have had the right drugs and equipment to apply treatment. But no longer. Life-saving equipment has been withdrawn from emergency ambulances, and drugs and equipment have been removed from community first responders. It is something that all Staffordshire MPs—Labour and Conservative—feared. We warned the Prime Minister and the Secretary of State for Health, and we are now witnessing a tragedy unfold before our eyes.

I shall give way in a few moments, once I have developed my argument.

The tragedy will unnecessarily reduce standards of care in the NHS, and people have estimated that it will cost many lives each year in Staffordshire. If it is not halted, the clock will start ticking with the first death. Let me be clear: this debate is all about saving lives and praising the paramedics and community first responders who are so professional in their work in Staffordshire. However, they are being let down badly by the lack of leadership, the weakness and the unprofessionalism of some of their senior management.

Although Ministers provoked the problem through their merger plans with the West Midlands ambulance service, there have been unintended and avoidable consequences. I shall go further, and say to the Minister that the Department of Health has been professional and consistent in its advice to the management of Staffordshire ambulance service. They have chosen to ignore it, and to risk lives as a consequence. I hope that the Minister will pass on my praise to the health professionals in his Department, whose letters I shall quote from later.

Roger Thayne—the former chief executive of Staffordshire ambulance service, who built it up to become the great service that is now so under threat—and many others estimate that 20 lives or more will be lost unnecessarily in Staffordshire each year, because of confused and bewildered management. They have a lot to answer for.

I intend to expose to the Chamber the web of deception and lies that has engulfed the new management of the Staffordshire ambulance service ever since the Government announced their intention to merge it with the West Midlands ambulance service. Before that announcement, Staffordshire ambulance service had been demonstrating the kind of leadership in public care that was the envy of communities throughout the United Kingdom—and overseas.

When Staffordshire ambulance service recognised that most lives were saved in the first five minutes after an emergency, and that it would never be able to secure the resources to provide a rapid emergency ambulance service to rural areas, it set up progressive, community-focused initiatives. They included teaching first aid to children as young as five, and making defibrillators available in local areas. That common-sense approach resulted in the Staffordshire service achieving the UK’s quickest response times and some of the country’s highest survival rates. Cardiac arrest outcomes were about five times better than the national average, and four-and-a-half times better than in the area served by the West Midlands ambulance service.

In a national context, if all ambulance services were as successful as the Staffordshire service was—it is important that I have to use the past tense—the NHS would discharge each year between 4,000 and 5,000 more patients alive than dead. Staffordshire did all that while maintaining costs to the taxpayer which were 30 per cent. lower than the national average. A success story, indeed.

I shall discuss two issues. The first is the drugs that have been withdrawn from community first responders, or CFRs, and the second is the ResQPOD units that have been removed from CFRs, regular ambulance crews and paramedics. One of the most important and successful initiatives developed by the Staffordshire service is the community first responder service. Those local volunteers are highly trained, and they are supplied with the necessary drugs to treat heart attacks, asthma, epileptic fits, injuries due to falls, or serious trauma. They start the treatment that is continued by a community paramedic, who is also based locally, which is in turn continued by an emergency ambulance crew. All CFR work is supported and overseen by a doctor, who is available 24 hours a day and provides instruction over the phone. Often, CFRs reach an emergency first, in those life-saving minutes immediately after an incident.

Why have the new management of Staffordshire ambulance service, in the shape of chairman, Robert Lake, and acting chief executive, Geoff Catling, removed vital drugs from CFRs and life-saving equipment from paramedics and trained volunteers? We can only speculate. They blame the law, the Government and the Medicines Act 1968. However, that is a lie, as I shall demonstrate later.

One possible reason for the removal is that a West Midlands ambulance paramedic, not from Staffordshire, who is a paid UNISON official, first raised the issue of CFRs carrying life-saving emergency drugs and equipment through his concern that paid paramedics and ambulance crews would lose out on overtime and job opportunities. We do not have such problems with industrial relations in the Staffordshire ambulance service, thank God. In any event, Staffordshire CFRs are never used as an alternative to the ambulance service; for all 999 calls, a paramedic and/or ambulance is called out. CFRs simply arrive on the scene more quickly, as they are based in the area; I want to reassure UNISON, a good and constructive trade union, of that fact.

A quick response time is not enough, however. Without drugs and equipment, CFRs cannot do their job.

Is my hon. Friend aware of the Coppice Lane estate in my constituency? It is effectively cut off by a railway line, which creates enormous problems, because there are no facilities available with the proper equipment and medical care.

I used to represent Stone, before a boundary change, so I know the area. My hon. Friend is absolutely right. Indeed, there are many other areas like that in rural Staffordshire. At this point, I should like to heap praise on the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) who has been only too aware of that very problem in her own rural constituency.

Why has the change taken place? The excuse given by Lake and Catling for withdrawing drugs and services is that their use is illegal under the Medicines Act. The Act prescribes which drugs can be administered by whom and under what circumstances, such as emergencies. It also outlines clinical governance for the storage and distribution of those drugs. That news first became public when on 17 October, NHS West Midlands head of special projects, Steve Coney, wrote to Members of Parliament and others informing them that all but three drugs previously available to save lives were to be withdrawn. Confusingly, the very next day, Staffordshire ambulance service issued a press release saying that, actually, six drugs remained available.

The press release was supported by correspondence from acting chief executive, Geoff Catling, who wrote to MPs and others. In his letter from the Staffordshire ambulance service, he said:

“Following an initial investigation, I have taken the decision that certain drugs used by our community first responder (CFR) schemes are to be withdrawn…whilst the training of the CFRs is extensive”—

I am glad that he admits that—

“and to a high standard, concern has been raised”—

by whom, we do not know—

“that under the Medicines Act, it would appear that a number of drugs are not eligible for use by lay people under the national legal framework for medicines. Now that the status under the Medicines Act for certain drugs is clear, the consequence is that the Trust can no longer provide indemnity to CFRs who may be operating outside the legal framework of the safe and secure handling of medicines.”

The indictment is clear. He blames the Medicines Act and the Government. He is right that the Medicines Act is clear, but it is not as he misleadingly claims. The use of the drugs is entirely legal—an opinion consistently supported by the Department of Health and the Medicines and Healthcare products Regulatory Agency. I have a letter from Victoria Milnes at the Department of Health’s customer service centre:

“The view of the Medicines and Healthcare products Regulatory Agency is that community first responders are in a similar position to Trust employees if they:

a) are engaged by a Trust to provide emergency response services as part of the Trust's business”,

which they are,

“b) are trained by and subject to the direction and control of the Trust”,

which they are,

“and

c) work on its behalf and are fully accountable to it”,

which they are. The letter goes on to say:

“This means that they can be supplied with appropriate drugs by the Trust without contravening the Medicines Act.”

I have a further letter from the MHRA, the executive agency of the Department of Health.

I will just quote from it, and then I will give way to the hon. Lady. The letter says:

“The Agency has taken the view that if community first responders in Staffordshire were engaged by the Trust to provide emergency response services as part of the Trust’s business, are trained by and subject to the direction and control of the Trust, work on its behalf and are fully accountable to it, they are in a similar position to Trust employees: i.e., they can be supplied with appropriate drugs by the Trust without contravening the Medicines Act.”

The hon. Gentleman quoted from a Department of Health letter. After that quote, an additional paragraph mentions the importance of ensuring that

“clinical governance arrangements are sufficiently robust to ensure safe and effective practice.”

Is that not the problem that Geoff Catling and Robert Lake have picked up—the training of CFRs?

That is indeed what they are talking about, and I shall address it shortly, but it too is an excuse and a lie, as I shall point out later. CFRs in other ambulance services with fewer controls than the Staffordshire ambulance service use those drugs. It is an excuse, and the hon. Lady and other Members of Parliament should not be befuddled by excuses. The drugs are used by other ambulance services, and they have the approval of the Department of Health. I shall come to that in more detail shortly, but I am grateful to the hon. Lady, who has been a doughty defender of CFRs, for raising the issue.

No, I will not. I want to move on, because I have quite a bit to talk about and other people want to speak. I shall give way to my hon. Friend later, because I know that he will have a chance to speak during the winding up.

Seven drugs have been withdrawn from CFRs: Atrovent, diazepam, Entonox—a gas—glyceryl trinitrate, midazolam, Pulmicort and Salbutamol. They are used to treat life-threatening asthma, prolonged and repeated fitting, severe pain, cardiac chest pain, childhood croup and severe pulmonary conditions. In each case, the Medicines and Healthcare products Regulatory Agency says that it is legal to provide the drugs, as they are administered orally, nasally or rectally and are therefore not covered by medicines legislation.

In fact, where the Medicines Act does restrict use of certain medicines—parenteral medicines, which are administered by injection—there is no bar to anyone using them in an emergency situation in order to save a life. Two such medicines, adrenaline and glucagon, are still being used by Staffordshire CFRs. There is no bar to CFRs using the drugs. Indeed, they are still being used by CFRs with less training in other ambulance services which have fewer protocols for keeping the drugs, including east midlands and Northumbria, where they are still being used to save lives, just as they could be used to save lives in Staffordshire. Who do the Staffordshire management think they are kidding?

In addition to the specific legal restrictions—this is the point raised by the hon. Member for Staffordshire, Moorlands—trusts need to ensure that their clinical governance arrangements are sufficiently robust to ensure safe and effective practice. That includes appropriate logistics as well as internal regulation and audit procedures. However, ever since the CFR programme began, Staffordshire ambulance service has had measures in place to address that—measures more complex and robust than in other ambulance services where the drugs have not been withdrawn. Whenever a CFR administered a drug to a patient, that drug was replaced from the back-up ambulance under the same procedure that paramedics use. It is a simple one-for-one arrangement that worked perfectly well. The details of the drug—its name, amount, batch number and expiry date—were recorded on the patient report form that accompanies the patient to hospital, and the ambulance service permanently retained a carbon copy.

I understand that a more strict and cumbersome arrangement is being devised in Staffordshire, but I know from the CFRs themselves, as I am sure the hon. Lady does, that even though the present arrangement is being used quite appropriately and legally in other ambulance services, CFRs in Staffordshire alone are happy to accept the added burden of paperwork if it means that they can continue saving lives. Let us not forget that they are volunteers who have undergone eight months of training and that many of them are doctors or have medical backgrounds—as I keep saying, they have a greater depth of training than CFRs in other regions, all of whom are allowed to use the drugs—and let us be clear that there has not been a single improper incident with the drugs and that many lives have been saved as a result.

The hon. Gentleman mentioned that some of the CFRs are doctors. Is it not the case that a doctor would be able to administer all 13 of the drugs?

Yes, but some of the CFRs are not doctors. They get to the scene first. Just as in other parts of the country, they were able to prescribe and give the drugs. They are not being allowed to do so now, and people will begin to die one by one in consequence. I repeat that there has not been a single improper incident involving the drugs during the past few years, and that many lives have been saved as a result.

I move to the question of equipment. As if taking such medicines from the first people on the scene was not bad enough, the new management of Staffordshire ambulance service have also withdrawn from all their emergency response teams, including regular ambulances, equipment proven to save lives in serious heart attack cases. When someone has a cardiac arrest, there are just a few minutes to save their life. Defibrillation does not always work, so cardiopulmonary resuscitation, which I have used, must be applied directly to the heart. I can tell you, Mr. Amess, that it is hard work. It can crack the sternum and break ribs, but compressing the heart manages to circulate some of the blood supply. That circulation is only 25 per cent. of normal circulation, which often is not enough.

ResQPOD is a device that artificially increases the amount of oxygen in the blood, thus getting more oxygen to the brain, heart muscle and other vital organs, and it increases the amount of oxygen that circulates under CPR by about 50 per cent. ResQPOD has been withdrawn, and again, our management friends, Mr. Lake and Mr. Catling, feature in this sad story. They cite safety reasons, but I have spoken personally to Dr. Keith Lurie, professor of internal and emergency medicine at the medical school at the university of Minnesota in the United States, and the reasons given for the decision taken in Staffordshire are spurious.

Let us be clear; we are talking about dead people, those whose hearts have stopped. ResQPOD is a life-saving device, and Lake and Catling—alone it would seem—are claiming that it is not. Yet it is used by other ambulance services in the United Kingdom—although, interestingly, not by the West Midlands ambulance service—and by ambulance services in the United States, whose legal system would soon see to it that it was quickly withdrawn from service if there were any doubts about its safety. It is also used in Canada, France, Germany and Scandinavia. I trust their judgment; I do not trust the medical judgment of Lake and Catling.

The future of the LUCAS unit is also in doubt. It is a mechanical device that provides chest compression during CPR and it effectively does the job of a paramedic by compressing the chest at a rate of 100 compressions per minute, which is very difficult to achieve or sustain. Anyone who has tried CPR will know how hard it is to sustain that rate for a minute or two, but the device does it automatically and indefinitely. It has not been withdrawn yet, and I hope that it will not be.

Each year, out of every 1 million people, about 1,000 suffer a cardiac arrest and will receive CPR. Fewer than 50 of those survive if manual techniques alone are used. If ResQPOD is used, the chances of a patient surviving a serious heart attack is doubled. If a LUCAS unit is used in combination with ResQPOD, and only if it is so used, the chances double again. Together the two devices keep blood flowing to and from the heart at 50 to 70 per cent. of the normal rate, which is much higher than the 20 per cent. figure achieved from the use of manual CPR alone. In Staffordshire, an average of 20 lives are saved; they will not be saved next year if the ban continues. That has all come about since plans for regional ambulance services were announced.

I have said from the outset that I want the best for the people of Staffordshire, the west midlands and the UK. I do not mind in principle if services become regional, or even national, as long as the service is, at the very least, as good as it is in Staffordshire. However, because Staffordshire has been consistently at the top of the performance tables for all measures of good service, such as response times and survival rates, it is the regional service that must improve—not the other way round. Lake and Catling say that response times are still tops, and for once I agree with them. That is great, but arriving swiftly at the scene is just part of the equation: without the vital drugs and equipment, paramedics, CFRs and ambulance crews can do nothing.

It is increasingly clear that the new management have an eye on the regional service, with the result that the people of Staffordshire are already beginning to suffer through the withdrawal of life-saving medicines and equipment. The morale of those who work so hard for the people of Staffordshire is already beginning to fall, through no fault of their own. I dread to think how many lives will be lost in Staffordshire when all the hard work they have put in to building a system that works simply evaporates because the regional service will not open its eyes to a common-sense approach. As I have said in this Chamber before, the Minister should be proud of what we have achieved in Staffordshire, and should want to repeat it elsewhere.

Before I close, I shall give the House some statistics and an example. Each day since 18 October, when Staffordshire ambulance service decided to restrict medicines, a CFR has been forced to wait helplessly with a patient, waiting for up to 45 minutes before a medicine that they could have administered on 17 October was administered. I shall read an extract from a message sent by “call sign 699”, who is a Brewood CFR group operator:

“job no:- 30/11/06/337 (Staffordshire Ambulance’s 337th incident last Monday), time 17:39, age 83, trauma (shaft femur), (broken thigh bone, near the top, the jagged ends will have been pulled by her thigh muscles so they overlapped, shortening the leg by about three inches—making diagnosis easy and the pain terrible) drug required:- entonox (gas and air–50 per cent. nitrous oxide, 50 per cent. oxygen—it would have dulled the pain enough to have allowed the ambulance crew to move her onto the ambulance as soon as they arrived; instead there was a further delay of about ten minutes while they set about dulling the pain”.

That drug could previously have been administered by CFRs and it has been unilaterally withdrawn by the Staffordshire ambulance service, even though it is in use by other CFRs in other parts of the country. The message continues:

“time for back up—14 mins (not bad: imagine an accident like this happening up in the Moorlands in a blizzard when the air ambulance can’t fly and the land ambulance is stuck on the Leek to Buxton road. How long would the poor old lady have had to wait for pain relief then?)”

That was sent by a community first responder called Ann.

It can easily take an ambulance 30 minutes to reach some areas—longer in winter—and we should note that the air ambulance does not fly at night or in bad weather. It is telling that no one from the West Midlands strategic health authority or the West Midlands ambulance service has visited a Staffordshire CFR group to see how it operates or to see the nature of the terrain. CFRs and community paramedics get into remote areas and deliver life-saving support—the Minister should note that it is a success story. However, although they are still the first on the scene of an emergency, they are no longer able to help. In the worst cases, they will be forced to watch someone go into cardiac arrest before they can attempt to help, knowing that before vital medicines and equipment were removed by the Staffordshire ambulance service’s management, they could have prevented it from happening.

The merger or “partnership”, as it is called, between the Staffordshire and the West Midlands ambulance services is developing into one of our worst fears. No sensible explanation has been given as to why, in the build up to the merger, drugs and equipment still in use in other ambulance services in England and elsewhere were suddenly considered to be illegal or dangerous for use in Staffordshire. The action by Staffordshire ambulance service to withdraw CFR drugs and ResQPOD is down to a major clash of cultures and, as it is neither practicable nor permissible for an ambulance service to operate different standards in a region, it is easier—and, I guess, cheaper—to restrict the medicine and equipment that Staffordshire’s emergency medical services carry than it is to train its colleagues in the west midlands.

It is disheartening to note that, perhaps uniquely, by merging the two services and ignoring best practice there is a real risk that clinical care will be reduced and operating costs and deaths will go up. The question that I put to the Minster is this: if community first responders and paramedics cannot treat emergency patients with appropriate medicines and equipment, why is the ambulance service still dispatching them? If that is being done to meet response time targets, it is surely a despicable misuse of volunteers that cheats patients because, without the vital drugs that have been withdrawn, the CFRs can do little when they arrive.

I started the debate with a figure. People in Staffordshire are nearly five times more likely to survive a heart attack than the national average. The people of Staffordshire in such circumstances are now five times more likely to die. I urge the Minister to use all the power of his office to sort this mess out because he will have a much more serious debate on his hands as soon as the first life is lost that could have been saved. The clock starts ticking with that first unnecessary death. I, for one, do not want that debate to be necessary.

Order. The winding-up speeches will begin at midday. Four hon. Members wish to speak and I want to call all of them, so I hope that they will share the time out between themselves.

I congratulate the hon. Member for Lichfield (Michael Fabricant) on securing this important and timely debate.

Passions have been running high in Staffordshire ambulance service over the past few weeks, especially since 17 October, when the bombshell was dropped that the 13 drugs that were previously available to community first responders had to be restricted to just six. As acting chief executive Geoff Catling admitted, withdrawing those drugs was like cutting off one of their arms. However, his view was that he had no choice but to make that decision, to protect both the community first responders, and the trust and its legal position. He said that the issue was a legal minefield. The problem concerns the interpretation of the Medicines Act 1968 and who can be responsible for the safe and secure handling of medicines.

On the other side of the argument are people such as John Jones, team leader of the Biddulph Moor community first responders, who says that there is no legal reason why he and his fellow community first responders cannot be allowed to administer all the 13 drugs that they have used for the past seven years without any problems at all. I fully understand their frustration. Community first responders are not just gifted amateurs; they are professionally trained to ambulance technician standards.

The community first responder schemes in Staffordshire operate under strict criteria for recruitment, personal specification, training, assessment and hands-on exercises. The schemes are maintained and managed by a qualified paramedic, and all community first responders, like trust employees, have 24-hour access to a trust doctor via the telemedicine desk in ambulance control. That allows online advice and a second opinion if appropriate, which ensures patient safety.

Let us be clear about the vital role of community first responders. They are local volunteers, operating mostly in the more remote rural areas, which is important in my constituency. There, the ambulance response may be a little slower, so community first responders are nearly always the first on the scene. They do not know what they will find when they arrive, but they have the professionalism, the bravery and the commitment to assess the situation and to take control until the ambulance gets there.

Staffordshire ambulance service emergency response times are the best in the country, and have remained so, but in remote rural areas such as mine, the weather, terrain and isolation can cause a delayed response. That means that those who volunteer to become community first responders are life savers. There is no doubt at all about that. Restricting the drugs that they can use has angered, demotivated and undermined the community first responders.

The view of the Medicines and Healthcare products Regulatory Agency is crucial. It has issued a statement—part of which the hon. Member for Lichfield read out—that says:

“The view of the Medicines and Healthcare products Regulatory Agency is that community first responders are in a similar position to Trust employees if they…are engaged by a Trust to provide emergency response services as part of the Trust’s business…are trained by and subject to the direction and control of the Trust; and…work on its behalf and are fully accountable to it.”

Community first responders clearly meet all three conditions. The MHRA continues:

“This means that they can be supplied with appropriate drugs by the Trust without contravening the Medicines Act.”

However, as I indicated earlier, there is another paragraph, which is where the problem arises:

“However, in addition to the specific legal restrictions, Trusts need to ensure that their clinical governance arrangements are sufficiently robust to ensure safe and effective practice. This would need to cover issues such as the training of community first responders, guidance on the use of medicines, storage and stock control”.

The hon. Lady is correct to read that out and I am grateful to her for doing so, but she will know that the previous chief executive sought advice on those very issues. He was assured that the standards of logistics, training, storage of drugs and so on met those requirements, which, moreover, are tighter than those that are in place in Northumbria and the east midlands, where the drugs are still being used. Why has it suddenly been decided that the protocol is illegal, when previously the protocol, which had been considered by the Department of Health, was judged to be legal?

I am coming to that issue. What the last paragraph of the MHRA’s statement indicates is that the Staffordshire ambulance service needs to ensure that the training of community first responders and the guidance on the use of medicines, storage and stock control are up to full scrutiny.

The training of community first responders in Staffordshire is certainly more extensive than in any other training regime for community first responders, with a minimum of 160 hours, proper assessment, five shifts with ambulance staff, and hands-on experience of up to 16 hours. The training regime is similar to that for ambulance technicians, but the problem seems to be that it is not approved or accredited by an outside medical body. I understand that it is provided by Northern college, which does not even award any qualification.

That seems an awful waste, because many people spend more than eight months, and sometimes nearly a year, training to become community first responders. They put in all that time and effort, entirely voluntarily, yet at the end of the training they do not receive any recognised qualification. They are regarded by the trust as lay people, when they clearly have a lot of expertise and are, in effect, ambulance technicians. The acting chief executive, Geoff Catling, is going to look at the training syllabus, but I do not understand why that has not been done before. Although there might be an issue concerning the amount of hours that community first responders can spend with a qualified paramedic or technician, the training is virtually identical to that of an ambulance technician.

It is nearly six weeks since the drugs were withdrawn, and I am concerned that there is evidence that some community first responders are voting with their feet. Some are not responding to certain calls. The problems centre on the withdrawal of Salbutamol, GTN and Entonox, because the community first responders now cannot offer relief for an asthma attack, treat chest pains or offer pain relief for trauma. They cannot use those drugs and therefore have to sit back while they wait for the ambulance. They can use treatments such as adrenaline in certain circumstances, but often they have to sit back unnecessarily while the patient is suffering, even though they know full well how to relieve that pain.

The Staffordshire ambulance working group is meeting tonight to try to find a way around that problem, but for us all, particularly the community first responders, things are taking far too long. The withdrawal of the drugs is clearly a temporary measure, but many community first responders are becoming disillusioned. Perhaps it is not surprising that conspiracy theories abound, many of which we heard from the hon. Member for Lichfield. According to those theories, the decision is supposedly about dumbing down the Staffordshire ambulance service and reducing its effectiveness, so that a merger with the West Midlands ambulance service can come about. That is because a merger will not take place until the performance of the West Midlands ambulance service matches that of the Staffordshire ambulance service. However, all the talk of dumbing down does great discredit to the hard work that is done in the ambulance trust every day of the year.

The same sort of claims have been made about the withdrawal of the ResQPOD. However, that decision was prompted by none other than Dr. Anton van Dellen, the former deputy chief executive and Roger Thayne’s right-hand man. Anton was concerned about the theoretical risk of fluid accumulating on the lungs when the ResQPOD was used with the LUCAS device, normally known as the “thumper”, during the treatment of cardiac arrest. The opinions of three external experts have now been sought, and their recommendations are now with the director of clinical performance, Dr. Matthew Wise, for his consideration.

I am familiar with the ResQPOD device. It is interesting. On the issue of blood arising in the pleura, one has to remember that the patients are dead. The experiment was done two and a half years ago and there is some doubt about it. As I said, if there were any doubt about whether the ResQPOD is safe, would it be as widely used as it continues to be in other ambulance services in the United Kingdom, the United States, Canada, France, Germany and Scandinavia? That experiment is irrelevant. Once again, only in Staffordshire do we suddenly discover that such things are an issue.

I bow to the hon. Gentleman’s greater medical knowledge, but Anton van Dellen is and has always been well respected in the trust. I do not believe that he would decide—and it was his decision to make—to withdraw the ResQPOD unless he was worried about it. He originates from South Africa and has huge experience. He is well respected by paramedics, management and community first responders. The decision had to be his.

In conclusion, I should say that there is real concern in the Staffordshire ambulance service about the withdrawal of the drugs and the ResQPOD. A very long time has passed, certainly since the ResQPOD was withdrawn from service. I urge the Minister to involve his officials to try to speed up the process.

We are coming up to the Christmas period, when community first responders will clearly be in great demand. I urge the Minister to try to ensure that there is a decision before Christmas on both the drugs and the ResQPOD, so that the performance of Staffordshire ambulance service can continue to be as great as always. As yet, there has been no evidence that those withdrawals have led to lower performance on the part of the ambulance trust.

I have no problem with the partnership between Staffordshire and West Midlands ambulance services. That has nothing to do with the withdrawal of the ResQPOD or the drugs. However, it is important that we overcome the problem, because the future of our community first responders is very much at stake.

First, I congratulate my hon. Friend the Member for Lichfield (Michael Fabricant) on an excellent speech that contained a huge amount of apparently unanswerable technical information. I also congratulate Mrs. Jean Tabernor and Mrs. Ann Edgeller, who are here today, and all those who have contributed to the magnificent movement—that is what it is—in my constituency and elsewhere in Staffordshire to save our vital service and ensure that that is done properly. That was the burden of my hon. Friend’s argument, which remains on the table. I shall be fascinated to hear what the Minister says. I have a meeting with another Minister of State at 12.15 pm; I hope that this Minister will understand that I have to go. However, I shall read what he said afterwards.

One of the most compelling arguments is about the relationship between the consequences for people caught in the impossible circumstances in which a person has a five-times better chance of being saved in Staffordshire, and the consequences for those elsewhere in the country. The constituency of the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) includes an area adjacent to mine. All her remarks about the hill farm areas are extremely important, particularly given the extreme weather conditions that can prevail up there.

I was particularly intrigued by what I thought she was saying—that the merger would not take place until the regional arrangements were up to the same standards as Staffordshire’s. I do not know where she got that from; that has not been put forward by anybody else, at least to my knowledge. I shall be happy for her to intervene and correct me on that.

It has been made clear that the partnership board will propose a merger when the West Midlands performance is up to the standard of Staffordshire’s. It is made clear in the partnership documents that the Staffordshire ambulance trust will have to make a decision on the merger only when that would not jeopardise patients.

No doubt the Minister can make that clear, but it is certainly not commonly understood. Whether the West Midlands service manages to maintain such standards is crucial to how the operation would be conducted and how the merger would take place. I continue to oppose the merger, and it is not just a question of medical equipment and CFRs. There are profound reasons, to do with regional arrangements that preclude a proper service for Staffordshire people. I do not believe that it will be possible, in realistic terms, for the five-times proportional difference to be made up by an improvement in the West Midlands service as a whole. I would require an enormous amount of proof to be convinced of that. There is no evidence for it; it is just an assertion. I leave it at that for the time being.

My hon. Friend raised extremely serious legal issues. To say the least, I have been extremely annoyed at the Government’s responses. I am sure that my constituents have been as well, given that I have presented two petitions in this field of endeavour with something like 5,000 signatures from my constituency alone. For example, the Government’s response to my 8 February petition to Parliament was that no observations would be issued on the petition. I find that intolerable; the Government know perfectly well what is at stake.

I repeat what I have said before, although Labour Members will take exception to it; they have in the past. During the 7 February House of Commons debate, all nine Staffordshire Labour MPs failed to support the motion opposing the merger as expressed in the terms of reference. That is on record. I should also say that on 26 February, the Conservative-controlled Staffordshire borough council passed a motion opposing the proposed merger. All the Conservatives supported the motion; none of the Labour councillors present did so. That is the record. I find the behaviour of members of the Labour party somewhat disingenuous, although I understand the reasons for it. I do not want to deprecate the reasons for it in themselves, because I am sure that Labour Members have a proper sense of duty to their constituents. However, difficult dilemmas arise, and to my mind it is clear that when the test has come, members of the Labour party—in Parliament or the local council—have, in general, supported the Government’s position. That remains a matter of record.

On the question of legality and the important matters raised by my hon. Friend the Member for Lichfield and the hon. Member for Staffordshire, Moorlands in respect of the Medicines Act 1968, there may be a solution in the hands of Government. My hon. Friend mentioned correspondence from Mr. Catling, and the hon. Lady also mentioned correspondence that is on the record. I believe that there is a procedure that could be used in a serious dispute about whether the Medicines Act and other medical legislation is applicable, but it is open to the Government to determine whether to use it; that is, to go for a declaration in the High Court, as there is clearly risk of death—my hon. Friend made that clear—and the matter of five times proportionality is very serious. I do not believe that there is the slightest chance that the West Midlands arrangements will ever come up to the standard that has been set. These are questions of great importance; of life and death.

The hon. Member for Staffordshire, Moorlands said that people were no longer prepared to take the action that they took until quite recently. Apparently, some people are not taking up the voluntary activities that they did in the past. I suspect—I do not know for sure—that the authorities in question have acquainted them with questions about insurance and negligence, and exposure even to legal action if they were to continue to provide services. So we have not only the differential in respect of potential for death as a result of the failure to make proper arrangements—that is in the hands of the Government and the trust—but the question whether the people who could provide the service have been warned off.

There are doubly good reasons why such matters should be taken up by the Government. Merely providing an opinion may or may not be sufficient. First, because the situation is serious, the Government should take leading counsel’s opinion, and that may need to be tested in the courts if we do not get the right answer.

I remain opposed to the merger. It will not work. I congratulate my hon. Friend on his expert analysis of the situation, and I concur with his conclusions. In this matter, the Labour party as a whole has failed the people of Staffordshire over an extended period. I await what the Minister has to say, but there is absolutely no evidence in anything that I have heard so far that the merger will be called off and/or that the situation for the people of Staffordshire will be materially improved in respect of the matters raised by my hon. Friend.

I shall try to be brief, Mr. Amess. I, too, congratulate the hon. Member for Lichfield (Michael Fabricant) on obtaining this debate on an important subject in Staffordshire at an important time. However, his blame of the trust management is ill-judged. As Staffordshire Members of Parliament, our united voices should be directed at the Minister, who should be spending time daily to sort out the problem until it is resolved.

Let us remember that Staffordshire ambulance service is the best in the country. The Government’s target is for three quarters of class A emergency calls to be responded to within eight minutes. Even in the past 12 months, Staffordshire exceeded that target every month. It usually performed at between 86 and 87 per cent. That is why it is the best performing ambulance trust in the country.

It is also why, apart from London, which was not involved in the merger configurations, Staffordshire was the only ambulance trust that was not forced into a merger with a bigger organisation. That was a recognition by even the Department of Health that it is the best performing ambulance trust in the country. Because there is now a West Midlands ambulance trust, the Government directed that the two trusts must work together to raise standards throughout the west midlands so that eventually there can be one West Midlands ambulance service. That is why a partnership direction was given, and why there is a partnership board. It is no surprise to me that issues have arisen as the practices of both trusts are examined and questions are asked about the legality of this and the clinical effectiveness of that. A responsible board such as that of the Staffordshire ambulance service trust must take seriously allegations of clinical ineffectiveness or illegality when it decides how to respond to an outside allegation, and that is what has happened.

Several setbacks have occurred during the past six months. The service lost several patient transport contracts—that was not because of the board’s leadership or the Department but because of withdrawal of the ResQPOD. The decision was taken on clinical grounds, as my hon. Friend the Member for Staffordshire, Moorlands (Charlotte Atkins) said.

Probably the biggest single reason why Staffordshire has the best ambulance trust in the country is the excellent leadership of its former chief executive, Roger Thayne. He is a man who takes innovation to a new level, especially in the national health service. Some of the issues that he left to the ambulance trust are now occupying the time of the partnership trust. Roger himself contributed to one of the difficulties of the past six months when he questioned the legality of some of the directions given by the Department in the partnership direction, and the ambulance trust had to obtain legal advice on the issue. There was also the suggestion by a whistleblower that the trust was not collecting figures on response times properly. That has been dealt with and put to bed.

The hon. Member for Lichfield raised the latest difficulty, which affects the community first responders. The question originally was whether the seven drugs that were withdrawn in October were being held and administered illegally by volunteers, in contravention of the Medicines Act 1968. I believe that the issue has now been resolved to everybody’s satisfaction. The regulatory authority, the Department, and the regional and strategic health authorities all accept that the Act does not provide a valid objection to community first responders holding and administering those drugs. The debate has moved on to whether applicable pharmacy rules would restrict their use. That is the remaining issue, and the Minister must resolve it as soon as possible. I echo what others have said about it.

In the meantime, the ability of an absolutely brilliant arrangement in Staffordshire—it was another of Roger Thayne’s innovations to use community first responders, especially in isolated rural locations—to augment the excellence of the ambulance service is being restricted. That is causing anger, demoralisation and despondency among people who know that they can help yet have both their hands tied behind their back until the issue is resolved. That is the urgent matter in today’s debate, and that is what I want the Minister to respond to.

I shall try to be brief, Mr. Amess. I congratulate the hon. Member for Lichfield (Michael Fabricant) on securing this debate.

Those of us who are not community first responders can only imagine how dispiriting it must be to attend an emergency and not be able to give the pain relief or other treatment that was available until the middle of October. My constituent David Holt, who is the secretary of the Staffordshire community first responders, is keeping a record of all incidents in the county in which patients suffer unnecessarily. In a briefing to Alex Fox, the chairman of the South Staffordshire primary care trust, he stated that, on average, once every day since 18 October a CFR has sat helplessly with a patient for up to 45 minutes waiting for a paramedic to administer Salbutamol, GTN or Entonox. What is even more frustrating for David Holt and the first responders of Mayfield in my constituency is that over the border in Derbyshire, East Midlands ambulance service recently trained its CFRs in the use of Salbutamol and GTN spray and issued those drugs to them. Mayfield and Ellastone CFRs used the drugs for four and a half years before 18 October without any adverse incidents.

I understand from David Holt that no one from the strategic health authority or the West Midlands ambulance service has visited Staffordshire CFR groups to see how they operate. I would urge them to do so. Having said all that, I can well understand the actions that the Staffordshire ambulance service, faced with the advice that it received from the strategic health authority in October, took to ensure that the community first responders were acting legally. It now seems clear that the advice, which according to the press release issued by Staffordshire ambulance service concluded that some drugs

“were not eligible for use by lay people under the national legal framework for medicines”

and that

“management policy falls outside the Medicines Act”,

was wrong.

In fact, even as long ago as July, the Medicines and Healthcare products Regulatory Agency stated in its e-mail to Staffordshire ambulance service that

“medicines legislation does not address the administration of non-parenteral medicines so there is nothing to prevent CFRs administering the remaining drug products in your letter”.

That e-mail was in response to a letter from the Staffordshire ambulance service that, I believe, listed a total of eight drugs, four of which are banned. All four of those drugs—Entonox, Salbutamol, GTN and diazepam—are non-parenteral and therefore are not covered by medicines legislation. Another two of the banned drugs that were not listed in the letter—Atrovent and Pulmicort—are also non-parenteral.

In a recent reply that I received from the MHRA, Professor Kent Woods confirms that the MHRA was not involved in the trust’s decision to withdraw the medicine. The letter clearly states:

“The Agency has taken the view that if community first responders in Staffordshire were engaged by the Trust to provide emergency response services as part of the Trust’s business, are trained by and subject to the direction and control of the Trust, work on its behalf and are fully accountable to it, they are in a similar position to trust employees; i.e. they can be supplied with…drugs by the Trust without contravening the Medicines Act.”

Professor Woods went on to say:

“The Trust’s clinical governance arrangements relating to use of medicines, documentation etc. do need to be sufficiently robust.”

We have now gone from a question of legality to a question of the clinical governance that needs to operate. I know that the CFRs are willing to have tighter protocols if that means that they can relieve the pain or suffering of those they attend before a paramedic or ambulance crew arrives. I have urged Staffordshire ambulance service to reach a speedy conclusion to this unfortunate situation.

We are grateful to Ministers for listening to our concerns earlier this year. I now urge my hon. Friend to press the strategic health authority for an urgent decision on the advice that they can give to Staffordshire ambulance service. It would also be helpful if he could give a clear reassurance that it is not about a dumbing-down of the service offered to Staffordshire people and if he could put an end to the conspiracy theories that seem to be circulating.

I join other hon. Members in congratulating the hon. Member for Lichfield (Michael Fabricant) on raising the issue. As we have heard from all the Staffordshire Members who have spoken so far, it is clearly an urgent issue that needs to be resolved forthwith. As the first non-Staffordshire Member to speak in the debate, I have been convinced not only today but in previous months of the quality of the service provided by the Staffordshire ambulance service. Hon. Members from the other two parties have repeatedly pressed the fact of the quality of the service in expressing their concerns about the proposed merger and I want to put on record my appreciation of all the work that is done by the paid staff of the service and the volunteers about whom we have heard today.

I find it strange, coming completely from the outside, that some fairly serious allegations are being made by the hon. Member for Lichfield, who has accused professional ambulance management of being liars and unprofessional. He clearly feels passionately about the matter. We have had some more measured contributions to the debate, too, but the key issue remains. In relation to the withdrawal of the drugs, has one ambulance service spotted something that no one else has? In a sense, that is sometimes the benefit of regional and local services; they can do things differently and if they have done so for a good reason, perhaps others should follow. I do not get any sense that, where Staffordshire ambulance service has led in terms of the withdrawal of drugs, any other ambulance trust has followed, although I am happy for the Minister to correct me on that. It seems that, although ambulance services are at liberty to consider the issue, it must not be allowed to go on.

I was interested that no one has so far referred to the letter from the chairman of Staffordshire ambulance service to the Staffordshire media, which is dated 16 November. He said:

“In regard to the actions taken to reduce the number of drugs that can be administered by CFRs in Staffordshire, the decision was taken…on the grounds of patient safety.”

He went on to say:

“We have always said that this action is a temporary measure”.

I find that quite interesting. I did not pick up from the speech made by the hon. Gentleman that the ambulance trust was saying that the measure was temporary. Clearly, that is what the chairman was saying in writing two or three weeks ago.

The chairman went on to say that

“we will re-introduce these drugs if, and when, it is legal and safe to do so.”

That is where the role of the Department of Health comes in. To some extent, the trusts are regional, devolved bodies that are charged with getting on with the job. If there is an inconsistency between what trusts are doing, if they are interpreting the law in different ways and if, potentially, patients in one part of the country are losing out, the Minister has a role to consider what is going on, the different practices and why different trusts might be getting different legal advice, and to try to provide some consistent advice to the trusts so that they can provide the same quality of care across the area.

With regard to the withdrawal of the ResQPOD, there seemed to be some discussion as to whether that was a clinical judgment, as the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) suggested. One person has judged that there might be clinical issues, and I understand from the debate that the ambulance trust has sought expert clinical advice from other people and is now considering it. That seems to me to be an entirely proper procedure. It would be wrong if any of those changes, as was intimated by the hon. Member for Lichfield, had been motivated not by clinical care but by organisational fiat or some political agenda. I was trying to work out quite what he was alleging. There were lots of hints, nudges and suggestions. I think that he was saying that the decisions are not being made because they are the right things to do or because there is some uncertainty, either about the legal position or the clinical implications, but because of forced harmonisation with the larger trusts.

I was not saying anything like that. I was saying that I do not know why it is being done. Why are there these questions when it is apparently perfectly legal to use such things in other ambulance services? Why are ResQPODs suddenly regarded as dangerous when they are used by other ambulance services throughout the world? We do not know the reason—we can only speculate, as I said in my speech.

What worries me is calling people liars and unprofessional, but only speculating on their motives. Clearly, my plea in this debate would be for transparency on the part of the trust. That is essential. The letter from which I quoted said that the decision to withdraw the drugs was

“on the grounds of patient safety.”

What triggered it? Who raised the issue of patient safety and what was the case? We need to know that, and whatever else has happened the trust should have been more transparent. We have some more understanding of why the ResQPOD was withdrawn. I hope that the clinical advice will be published—there is no reason why it should not be—and that the decision will be made quickly.

Transparency is important in such matters. In terms of NHS reform, the public sometimes legitimately worry that changes are being made not on a clinical basis but because of cost or some other agenda. When trusts are making decisions that they believe are to do with legal advice or clinical judgment, they can be open and up front about it. I do not see any reason for that not to happen.

During the debate, we heard that the hon. Member for Stone (Mr. Cash), who is no longer in his place, submitted a petition on the issue. It is disappointing when hon. Members of any party submit a petition with a large number of constituents expressing a concern and the Government decline to offer a comment. The Minister might feel that they had said all that there was to say, but it undermines our efforts as constituency MPs if we gather the views of thousands of our constituents and they are simply disregarded by the Department. I hope that the Department will consider its policy on responding to petitions and will think again about that.

We heard the hon. Member for Stafford (Mr. Kidney) praise the previous chief executive, who certainly seems to have done an outstanding job. His views have been placed on the record. The hon. Member for Staffordshire, Moorlands rightly raised the question of what has changed now, if the drugs have been used for seven years. We are talking about an Act that has been in force for 35 or more years, and that clearly has not changed, so why has the legal advice changed? What was the trigger? It comes back to my point about transparency; that is what we want. I take her point, which was also made by others, that many of the community first responders are well trained, highly skilled people who have been doing the job for a long time. I understand the frustration pointed out by the hon. Member for Burton (Mrs. Dean)—when people are on the scene, they want to do what they have been doing quite safely and they ought to be allowed to continue to do it.

In conclusion, I enter a plea for transparency from the trust. It should place on record much more fully the sequence of events that led to the two decisions. What advice did it receive, and where is it going? Will the Minister recognise the urgency that has been expressed in many of the speeches and try to resolve the inconsistencies where different legal or clinical advice has been given to ensure that the people of Staffordshire, as elsewhere, get the first-class ambulance service to which they have become accustomed?

I add my sincere congratulations to my hon. Friend the Member for Lichfield (Michael Fabricant). No Member more assiduously or ardently defends the interests of his constituents, or those of the Staffordshire ambulance service. On behalf of his constituents and of all the people of Staffordshire, he made a clear, robust and brave speech.

The reorganisation of the Staffordshire ambulance service—one of nine such reorganisations in nine years under this Labour Government—took place on the back of a spurious interpretation of Peter Bradley’s review and a sham consultation. The NHS Appointments Commission sent out letters two months before the end of the consultation asking for nominations for the chairmen and chairwomen of the new NHS ambulance trusts, at the request of the Department of Health. That was no doubt the process under which Messrs. Lake and Catling were appointed, as at the announcement of the merger proposal, Roger Thayne departed—to the great consternation and anxiety of the people of Staffordshire after such a wondrous spell as top guy.

One of the greatest travesties of the reorganisation was the treatment of the Staffordshire ambulance service. As I said in my response to the initial ministerial statement on the Floor of the House, the service has been put in the departure lounge. That debate was notable for the Minister’s dogged avoidance of a promise to protect the high standard of Staffordshire ambulance service.

I asked, as did my hon. Friends the Members for Lichfield, for Stone (Mr. Cash), and for South Staffordshire (Sir Patrick Cormack) and the hon. Member for Cannock Chase (Dr. Wright), for an assurance that no merger would take place until the West Midlands ambulance service trust had reached the standards of the Staffordshire ambulance service. No such assurance was given. It is increasingly plain to see why. It cannot or will not get there.

We warned and warned again. My hon. Friend the Member for Lichfield was too generous to the Government and the Department. They were warned, so the tragic consequences for the people of Staffordshire about which we have heard today cannot, by definition, be unintended. To ram something through, as the Department of Health has done with its mergers, despite being warned of the consequences that would inevitably flow from the change, means that Ministers intended the damaging consequences that have resulted. Unless they can account for themselves, they have no escape other than to be damned by their actions.

On the other hand, MPs across the House were reassured by the Minister’s promise to the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) when she asked him to confirm that

“Staffordshire ambulance service will remain operationally independent and that it will have its own trust board and its own chief officer, so that it can continue to run its system, which is completely different from those used by other ambulance services in the country?”—[Official Report, 16 May 2006; Vol. 446, c. 864.]

However, his answer turned out to be just warm words. Barely three months later, my hon. Friend the Member for Lichfield came across a leaked e-mail that made it clear that operational independence was being eroded by the very ministerial team that gave the guarantee. The e-mail, signed by a senior civil servant on behalf of the Secretary of State for Health, stated that the chief executive of the West Midlands ambulance service must now be invited to board meetings of the Staffordshire ambulance service and that his “advice” must be taken in all important decisions. In addition, there would be joint control of personnel, finance and IT functions. By reneging on his promise to protect Staffordshire’s operational independence, the Minister has reneged on his promise that the Government

“would not want Staffordshire ambulance service’s standards to be eroded in any way.”—[Official Report, 16 May 2006; Vol. 446, c. 860.]

The Staffordshire ambulance service is slowly being undermined, and the decisions spoken of in today’s debate carry the inevitable suspicion that it is being levelled down to the overall standard of the rest of the area under the West Midlands ambulance trust, bearing in mind Staffordshire’s consistent pre-eminent position at the top of all score sheets before the merger proposals were made.

At the time of the announcement, I and others demanded that if the West Midlands ambulance service had not reached the standard of Staffordshire within the arbitrary two years set out by the Minister, no merger should go ahead. The Home Secretary had guts enough to scrap the totally misconceived police mergers, but the Secretary of State for Health has been found wanting in every respect when faced with exactly the same choice.

Although the Minister would not accede outright to the merger not going ahead, he intimated to the hon. Member for Burton (Mrs. Dean) that the two-year time frame was not set in concrete should more time be needed for the West Midlands ambulance service to come up to scratch. However, it is clear that the current chief executive of Staffordshire ambulance service wants to speed up the process, and he appears to be under pressure from the Department. He said in the summer:

“The directions handed down show the merger with Staffordshire should take place by 31 December 2007, but that could happen sooner, maybe by the end of this year”.

I do not have the time, and the hon. Lady has already made her point in trying to defend the current management. Without taking the necessary steps to improve West Midlands ambulance service, the only way to speed up the process is actively to dumb down Staffordshire.

As we have heard, the ResQPOD was withdrawn, apparently on safety grounds. Every ambulance and paramedic car in Staffordshire carried one, but the West Midlands ambulance service does not use them. In addition, there have been fears that the LUCAS, often called the thumper, will similarly be banned—another device not used by West Midlands ambulance service. According to the NHS, people are four and a half times more likely to survive a severe heart attack in Staffordshire than in the rest of the west midlands because of the speed of response of the Staffordshire ambulance service and the community first responders and because of the training and equipment available to Staffordshire ambulance paramedic crews. Attempts to portray that decision as clinical fly in the face of the evidence—and, frankly, of reason. To say that it was done for reasons of safety is plainly a smokescreen for the politics of merger.

The latest development was the withdrawal on 18 October of seven of the 13 drugs administered by the community first responders. The trust invoked the Medicines Act 1968 to support that decision, but again a leaked e-mail from the Department of Health to the trust—I believe that it was sent on 26 July—saw no problem with all 13 medicines being administered by CFRs. My hon. Friend the Member for Stone mentioned an action for declaration if there was any question of doubt; the Minister has that within his gift and could order it today.

My hon. Friends in Staffordshire, the volunteer staff of Staffordshire ambulance service and the people of Staffordshire are having to fight tooth and nail to protect their ambulance service and community first responders. Patient choice was ignored with a sham consultation, and it continues to be ignored by bureaucrats bent on delivering a political and financial agenda rather than a clinical one. The Minister’s civil servants and the new chief executive of Staffordshire ambulance service need to account for the fact that they have not been able to keep the Minister’s promise to protect the people of Staffordshire by keeping their ambulance service at the level that they have enjoyed in the past, without suffering compromise in order to merge with the West Midlands ambulance service. It is right to ask the Minister: what has changed?

I, too, congratulate the hon. Member for Lichfield (Michael Fabricant) on securing this debate. I do not doubt his sincerity and strength of feeling on the matter. I also congratulate my hon. Friends the Members for Staffordshire, Moorlands (Charlotte Atkins), for Stafford (Mr. Kidney) and for Burton (Mrs. Dean) on their contributions to the debate. If every organisation in the NHS inspired such civic pride and as much interest and energy as the Staffordshire ambulance service, we would be in a good place.

The concerns expressed this morning are understandable, because the ambulance service provides the first point of access to health care for a wide variety of patient conditions, ranging from life-threatening emergencies to chronic illness and social care. The 12 NHS ambulance service trusts in England are the first and often the most important contact for the 6 million 999 callers each year. Of course, it is vital that patient care is not only safe but of a high quality. There has been a rising demand for the ambulance service. The latest figures for 2005-06 show 6 per cent. more calls than in the previous year and a 5 per cent. increase in the number of incidents attended. Despite that, improvements in response time continue.

I, too, take the opportunity to pay tribute to the hard work and dedication of staff at the ambulance service, including community first responders. Not long ago, I was a patient of the Staffordshire ambulance service, as I mentioned to my hon. Friend the Member for Burton. I had an accident on the M6, somewhere in the constituency of my hon. Friend the Member for Stafford. I was involved in a collision between a Government car and a foreign lorry. Even though the service knew I was a Government Minister, I was looked after very well indeed, which shows the professionalism and skill of the service.

On a more serious note, it seems that there is a high level of loyalty, commitment and passion for the job that the staff of the service do. That is to be commended. As part of that success story, the Government acknowledge the valuable support that community first responders offer as they are trained in life support and first aid, and are equipped with defibrillators. I gather there are 313 trained community first responders living in the boundaries of the Staffordshire service and a further 116 in training at present.

My hon. Friends mentioned individuals to whom they had spoken and I pass on my thanks and appreciation via them to their constituents for the work they do in supporting the NHS and, more generally, in helping people in the community who need support. At the same time, it is right for me to say as a health Minister that if we have people helping in our NHS it is vital that they operate within a proper framework of clinical governance and accountability. That, too, is an important consideration to bear in mind.

I have listened closely to the comments of the hon. Member for Lichfield and other hon. Members about the Staffordshire ambulance service. I also heard the plea for transparency that was made in a useful contribution by the hon. Member for Northavon (Steve Webb) and I agree entirely with him. Where changes are made, there should never be suspicion of an agenda that is anything other than patient safety. All of us as Members of Parliament should have that as priority number one, two and three regarding any changes that are considered in the national health service. Nothing should be done that knowingly compromises patient safety and I urge that clear statement to be the backdrop for what we are discussing.

The piece of equipment referred to as the ResQPOD, or impedance threshold device as it is also referred to, has been temporarily withdrawn from use by the Staffordshire Ambulance Service NHS trust. I understand that it was withdrawn because of concern regarding the theoretical risk of pulmonary oedema, which is fluid accumulating on the lungs, when ResQPOD was used together with another device—the LUCAS device—in the treatment of cardiac arrest. The trust felt that on the basis of the advice it received about the theoretical risk, it should suspend the use of the device and undertake a review, which it has been seeking external expert advice to assist with. I understand that the review has now been completed and that the recommendations are being considered so that a decision can be made by the trust as to whether or not to reintroduce the ResQPOD.

As my hon. Friend the Member for Staffordshire, Moorlands said, the advice came from the then medical director under the former chief executive that it was right and proper to withdraw based on evidence brought forward about the use of ResQPOD in connection with another piece of kit. In response to the hon. Member for Lichfield, I accept that there are international examples; I am not contradicting that. It is also important to say that no other ambulance trust in the UK is using the ResQPOD. External advice is being sought and the collective view of ambulance trusts is that a formal controlled trial of this piece of equipment is required before clear guidance can be given. I resent the comment made by the hon. Member for Eddisbury (Mr. O’Brien) to the effect that bureaucrats are bent on delivering a financial and political agenda. The suggestion that this is not to do with patients or patient safety does not further the quality of this debate one iota and was a mistaken comment to have made.

Clinical practice and governance of any group of individuals who are administering patient care is a matter that must be managed very carefully. The restriction of the number of drugs that community first responders in Staffordshire can administer as well as the equipment they use, is a matter for Staffordshire Ambulance Service NHS Trust. Staffordshire ambulance service has an obligation to ensure that it is providing a high-quality service and that it is acting in accordance with the law. When concerns were raised locally that the range of drugs administered by community first responders might be in excess of those permitted by the law, it is entirely understandable that Staffordshire ambulance service felt the need to take precautionary action while a review of its practice was undertaken.

I will now turn to the legal requirements that apply to the administration and supply of medicines. Under medicines legislation, the administration of injectable medicines is restricted. Unless self-administered, they may only be administered by an appropriate practitioner or anyone acting in accordance with the directions of such as practitioner. There is an exemption from those restrictions that allows anyone to administer a specified list of such products for the purpose of saving life in an emergency. Adrenaline and glucagon are examples of items on the list, which, as hon. Members know, are administered by community first responders in Staffordshire.

Apart from controlled drugs, there are no legal restrictions on the administration of non-parenteral medicines including those classed as prescription only medicines. However, the ability to obtain supplies of drugs is restricted. Controlled drugs are subject to additional legislation, which is set out in the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001. There are different rules depending on the type of drug, but generally they cannot be administered by anyone other than an appropriate practitioner or a person acting on the directions of such a practitioner. Examples of controlled drugs are diazepam and midazolam. Drugs such as those may not be supplied to community first responders.

The list of some of the drugs that have been in use was given and the hon. Member for Lichfield will know, as he referred to them, that diazepam and midazolam are among the drugs being used by community first responders. I have a list of drugs used by community first responders in ambulance services around the country, which indicates that diazepam and midazolam are not being used. However, there is variation and in other places a more restricted list of drugs is in use and advice has been taken about what constitutes appropriate practice.

When the Medicines and Healthcare products Regulatory Agency was asked for its views on the administration of drugs by the community responders scheme that advice drew the distinction between drugs for oral administration and those intended for injection. The agency’s advice was that, under medicines legislation, drugs for oral administration could be administered by community first responders in their capacity as “agents” of the ambulance trust and within the trust’s guidelines for the community first responder scheme. After the trust took the decision to withdraw the drugs, the agency drew the trust’s attention to the fact that two products were also subject to the additional requirements set out in the misuse of drugs legislation, as I have said. I hope that the hon. Gentleman will accept that this raises important questions of clinical governance and patient safety and it is right that time is taken to ensure that the legal basis on which any such products are used is clear so that everybody knows where they stand.

I would briefly like to pick up on some of the hon. Gentleman’s other points. He said that community first responders have to wait for 30 to 45 minutes for an ambulance in some parts of Staffordshire. I wish to make it clear that community first responders are not a substitute for an ambulance. For category A calls an ambulance should arrive within 19 minutes of the 999 call 95 per cent. of the time and in addition to the initial community first responder. He also said that patients will die because community first responders cannot do anything when they get there. Again, it is important to be clear that community first responders are not a substitute for an ambulance; they should be deployed to patients whom they have the training to deal with. Where they are deployed, an ambulance should also be dispatched to the scene and be there in 19 minutes or less. Those are important points of clarification.

Some of these issues have raised questions relating to the governance of the ambulance service. The Healthcare Commission has recently been in touch with the ambulance service and has highlighted a number of areas of concern that it has asked the ambulance service to address. For the purposes of this debate, it is important that there is urgent clarification. I accept that and the point made by my hon. Friend the Member for Stafford. We need urgent clarification and to give people working in the field—the community first responders—absolute certainty about the ground on which they are operating so that we can continue to use their good will. However, I would say that the Government, in allowing the time that they did for these issues to be resolved in terms of the discussions about the merger of the two services, have been proved right by this debate.