It is a pleasure to serve under your chairmanship, Mrs. Dean, and to be able to stand here today to demand a better ambulance service for my constituents. I thank Mr. Speaker for granting me this debate. I welcome the Minister to his new position, and I wish him well in what I hope will be a fruitful debate and the conclusion to the problems that ambulance services in Crewe, Nantwich, Cheshire and the north-west have experienced.

In the past 15 months, I have been engaged in a battle with North West Ambulance Service about volunteer ambulance services in Nantwich. The town had two highly visible and respected volunteer community first responders who provided a quick response to emergency health care incidents using a blue light emergency vehicle and a range of capabilities when they arrived on scene. Given that no paramedics were based in the area, local residents and the local council thought that that was an excellent service, which is exactly what it was. The dismay of all those concerned can be imagined when early last year the service was downgraded by North West Ambulance Service and continues to be so.

That downgrading has resulted in fewer calls—the number has fallen from 120 in December 2007 to just over 20 in February 2009. There have been fewer services, and according to the NWAS medical director, even aspirin is now a dangerous drug in the hands of community first responders, who should not have access to it as part of their medical kit. They are no longer allowed to use blue flashing lights, which is perhaps the most bizarre decision, given the findings of the Healthcare Commission’s report into the neighbouring Staffordshire Ambulance Service in 2008, which stated clearly that the first responders need sirens and blue flashing lights to operate safely and effectively. Does the Minister agree that as a matter of principle and common sense, when a community first responder has the necessary training to drive with a blue light—we cannot ignore the fact that its purpose is to ensure a speedy response to a life-saving situation to enhance the prospect of patient survival—it would be perverse not to allow them to do so? Sadly, however, that is what has happened in Nantwich in the past year.

The downgrading of community first responders resulted in what can only be described as local outrage. It led to my leading more than 1,000 residents on a protest march through a normally peaceful Cheshire market town. I understand that it was the first march in that town since the English civil war, which speaks volumes for the feeling among local residents. I also presented a 10,000-signature petition from local councillors, residents, first responders and so on to Downing street, and had the opportunity to raise the matter in a debate on the Floor of the House in January.

Fifteen months after the matter arose, we now have on offer a slightly downgraded service with a different mechanism that will, unfortunately, cost more. The current proposal is that retained firefighters will provide the service, but they are the same people who were providing the community first responder service as volunteers and unpaid members of the public. The blue lights will be back for properly trained drivers, but we had blue lights before and the drivers were properly trained. The range of services that those retained firefighters will be able to provide will be more limited than when the community first responder scheme operated before NWAS became involved.

I am sure that the Minister will do his bit and tell us what the North West Ambulance Service is doing and what it is providing, and he will no doubt back that up with marvellous statistics about its work. Although I have not yet seen written confirmation, which is unusual for such a bureaucratic organisation, a retained service has been promised, which will claw back most if not all the skills of our local community first responders. Such a guarantee would be welcome in writing—we have not received that—and I received a copy of a letter today from Nantwich town council to the area manager of NWAS making that point and seeking clarification of what is on the table as part of the retained co-responder firefighter/ambulance service.

According to 2006-07 figures, the service used to cost North West Ambulance Service £12 per call-out for volunteer first responders. The firefighters will be paid for the service that they provide, so where have we ended up after 15 months? It seems that we have less service, a year’s disruption, more cost to taxpayers, and disregard for hard-working volunteers. The problem is that NWAS seems to have no idea of how to handle community issues. The burden of bureaucratic meddling among its senior management has sometimes been astounding, and to the detriment of its concern for my real, living, breathing constituents whom they are there to serve.

To put that into context, in 2008-09 NWAS spent more than £620,000 on communications. It even spent just under £400 on an equality and diversity calendar this year. I am sure that that is a noble cause, but that money is equivalent to the cost of at least 20 first responder call-outs for the people of Crewe and Nantwich. How that image-conscious spending has helped response times in the north-west is beyond me, but it seems to have produced the poorest results in communication.

It is not just me saying this. The Cheshire county council scrutiny committee report on NWAS’s review of community first responders noted that

“there appears to have been no core principles underpinning the review”.

It was “surprised” that

“the review of CFRs was not the subject of a written report to NWAS’s Board.”

It also noted:

“NWAS may wish to review its approach to communications and consultations not only in the context of its statutory obligations on patient and public involvement, but also more generally.”

I suspect that the scrutiny committee was being polite in the terms that it used.

Where does that leave us? Nantwich, the surrounding area and, to an extent, Crewe now have in sight once again their own retained ambulance service. If that is the outcome, it will be welcome. We have been through some long and arduous meetings over many months. It should be seen not just as a single entity, but as a model for similar schemes across Cheshire and the north-west, including the village of Audlem, which is on the edge of my constituency, Sandbach, Congleton, Chester and Knutsford. It has, however, taken 15 months of effort from me, Nantwich town council, local first responders and members of the public to keep the issue on the boil and bring about a remotely acceptable outcome.

In the process, the Crewe and Nantwich public have marched against the ambulance service and voiced their concerns, staged other demonstrations and suffered a massive loss of confidence in that service’s ability properly to demonstrate a will to improve and provide for residents in our area. All that is combined with the ongoing problem of poor response times in our rural areas, with not one category A call being responded to within the target time for Audlem, near Nantwich, in a recent reporting period. That would be unacceptable to any area of the country, let alone Audlem.

As my hon. Friend the Member for Eddisbury (Mr. O’Brien), who shares a surname with the new Minister, has rightly pointed out to the House,

“community first responders are effectively filling a major gap that has arisen due to the inadequacy of the North West Ambulance Service”.—[Official Report, 21 January 2009; Vol. 486, c. 797.]

I am listening carefully to the hon. Gentleman and he makes his case very well, but I am not entirely clear on what he is asking me as a Minister to do. He is saying that he has concerns about the North West Ambulance Trust. He is well aware that the hon. Member for Eddisbury (Mr. O’Brien) is very clear that Ministers should not interfere with local trusts—that there should be no political involvement at all and trusts should be allowed to get on with the business of making decisions. What we are talking about here is a local trust that has made some decisions. The hon. Member for Crewe and Nantwich (Mr. Timpson) obviously disagrees with the hon. Member for Eddisbury, but what I am interested in is this: what is he suggesting that Ministers ought to do—intervene in this case?

I am not sure that my hon. Friend said exactly what the Minister has just said about what involvement the Department should have with the trust. He may be referring to some other occasion. I simply said that my hon. Friend had pointed out that community first responders were filling the gap that had arisen due to the inadequacy of the North West Ambulance Service. I did not mention what his view might be on the involvement of Government in the work done by the trust on the ground.

I was coming on to some of the things taking place in the trust that I think the Minister needs to be aware of. As part of the Department of Health’s response and guidance, clear boundaries need to be set as to exactly what is expected, to ensure that response times are being met not only regionally, but locally. That deficiency cannot just be left at the door of the trust; it has to involve the primary care trust and the Department of Health. We need to ensure that there is a joined-up response so that where there are failings in the service provided by our ambulance service, that is brought to the attention of the Department and it is not left believing that everything in the garden is rosy, because it clearly is not and has not been for some time in my constituency.

Let me raise one of the issues that I am pressing. The Minister can respond by saying what involvement he could have in trying to press this issue. If he does not feel that it is within his remit as a Minister to do so, I would like to know why. I am referring to the fact that until we move to the mandatory publication of local rather than regional response times, areas such as Nantwich will still face the dilemma of not knowing what the response times are in their local area and therefore whether the strict targets—they rightly are strict—are being met by the trust. I have already given the example of the failure in the Audlem area by the North West Ambulance Service to meet any of the eight-minute targets for category A calls.

I ask the Minister at least to respond to that point in his reply and to acknowledge that it is an issue that needs to be addressed, whether by him or by the trust, because it is clearly an unacceptable state of affairs. The North West Ambulance Service has let itself down badly, and the people of Nantwich should be congratulated on the strength and determination they have shown over many months in trying to deal with the issue. On many occasions, the wall that we have faced has been very high, and one that has not been willing to move. One of the reasons for being here today and bringing the Minister to the debate is to widen the issue out and bring it to the attention not only of the Department but of the public, so that they are aware of some of the issues being faced in the provision of ambulance services not only in Nantwich but throughout the north-west.

I hope that the Minister will strongly encourage the ambulance service to review how it engages with communities and encourage it to take this opportunity to bring a fresh pair of eyes from outside the organisation into the chief executive’s office, in order that all areas in the north-west may maintain a healthy confidence in their ambulance service’s ability to save lives and answer individual communities’ needs.

I started the debate by welcoming the Minister to his new post and by describing the last 15 months of dealings with the North West Ambulance Service over local ambulance service provision as an ongoing battle. I hope that with his fresh eyes on the issue and his intuition and incisiveness, we may be able to put that battle to rest. I am not asking for a miracle; I am not asking for a silver bullet. I am asking for recognition from the Department represented by the Minister that there is an issue that the trust needs to deal with to ensure that the public’s confidence in the service is back where it should be.

These people who serve our community do it out of the goodness of their heart. They have not been paid for it. The proposed new system will mean that they are paid, but I suspect that that is not their motivation. We need a service that ensures that lives are saved wherever possible, and the first responders are there to do that. I hope that the Minister will support that principle and advocate support for the first responders.

I begin by congratulating the hon. Member for Crewe and Nantwich (Mr. Timpson) on securing the debate. I also thank him for welcoming me to my new role. Before addressing in detail some of the concerns that he has raised, I want to recognise the excellent work that our ambulance staff do, so I shall make some general points before coming to the specifics of the hon. Gentleman’s contribution.

Day in, day out, ambulance workers save lives and care for patients, benefiting the people of Crewe and Nantwich and others throughout the country. It is thanks to their dedication and hard work that ambulance service performance has improved. At the end of 2007-08, the NHS ambulance service recorded its highest ever emergency response rate, with 77.1 per cent. of category A—life-threatening—calls receiving a response at the scene of the incident within eight minutes.

That best-ever category A performance was achieved despite increases in demand, with more than 7 million 999 calls being dealt with in that year—almost 1 million more than the year before. That success came despite significant challenges, including the new “call connect” clock start measurement, which affects the amount of time available to respond. The time that an ambulance takes to reach a patient is now measured from when the 999 call connects, which saves an average hidden wait of about 90 seconds, rather than being measured from the point at which the person who received the call passes it on to the ambulance service. That is a good record.

The hon. Gentleman is concerned about community first responders in Cheshire. It is obviously a matter that is raising serious unease among his constituents in Nantwich. CFRs were developed in response to the Government’s national framework for coronary heart disease. CFRs are trained in the use of automatic external defibrillators, which are used to treat patients in cardiac arrest. In the north-west, they operate a voluntary rota in groups of eight to 15 and respond to emergency calls in addition to the ambulance service, administering life support to patients while waiting for the ambulance to arrive.

CFRs play an important role in supporting ambulance services and in improving our response to 999 calls in many parts of the country. They are not, however, a substitute for an emergency ambulance response. The North West Ambulance Service NHS Trust is committed to its CFR schemes. Indeed, in April it established three new CFR schemes in Northwich, Winsford and Crewe. I can tell the hon. Gentleman that a pilot co-responders scheme is to be set up in Nantwich in his constituency.

It is obvious that the Minister has been given detailed information about NWAS and its policy on CFRs. He has mentioned co-responders. Will he provide more detail about what skills and training the CFRs will have? Will they be able to use those skills, for instance, to drive on a blue light?

Co-responder schemes are agreements made between the ambulance service and, in this case, Cheshire fire and rescue service. Firefighters will be trained to use lifesaving skills and will thus be able to respond to patients in the same way as CFRs. However, they will also be trained in other areas, such as casualty management, scene management, risk assessment and advanced driving under blue lights.

I note the point that the hon. Gentleman makes about CFRs being the same as firefighters. I have been told by officials that one CFR was a retained firefighter, not a full-time firefighter, and that he provided a CFR blue light service until 2008. In line with the review undertaken by the trust, that was revoked for reasons of staff, patient and public safety. I am informed that that is how that situation was dealt with.

The Minister has hit on the question at the heart of many discussions over the last 15 months. Will he confirm that the retained firefighter who was a CFR before the blue light was taken away was driving on a blue light under insurance provided through NWAS? Will insurance for the co-respondent scheme be met by the fire and rescue service or the ambulance service?

I am sorry to say that my valuable briefing does not extend to insurance cover, but I shall ask the trust and let the hon. Gentleman know. That is probably the best way to deal with that question.

It is likely that co-responders will be able to respond to a far wider range of incidents than CFRs. The trust feels that it is a good scheme and that it will give local people a good service. Although the scheme will take some time to be fully implemented, I understand that the pilot scheme in Nantwich is due to start at some point this year, hopefully as soon as August.

NWAS is considering a number of ways to improve its performance across the region, especially in rural areas. One such scheme will provide further training to CFRs, enabling them to be deployed to an increased number of incidents. The volunteers will also be paid for their time. Details of training and the scope of the exercise are being discussed, with a view to a pilot scheme being trialled in Knutsford.

I listened with care to the hon. Gentleman; he made an eloquent case on behalf of his constituents. However, the organisation of services, including CFRs, is not decided by Ministers or civil servants in the Department of Health but by local health care professionals. Organisational changes must be based on medical grounds and what is best for patient care.

To ensure the most effective and appropriate use of CFRs across the north-west, NWAS undertook a review of its services. It is a local health care organisation that consults and engages with local people, considers the arguments, talks to staff and others who are involved and reaches local decisions. It wanted to ensure that CFRs were used in the most appropriate and efficient way to ensure the safety of patients, the public and staff.

The review proposed the standardisation of services across the former ambulance trust areas of Greater Manchester, Cumbria, Mersey and Lancashire. It included the removal of the blue light facility and a review of the level of care that CFRs could and should provide. The proposals were referred to democratically elected councillors on Cheshire’s overview and scrutiny committee. That committee set up a task and finish panel to review all issues in detail. The panel reported back to the full committee in October 2008.

The overview and scrutiny committee made a number of recommendations, and NWAS has produced an action plan to address those recommendations. The action plan was shared with the OSC and other stakeholders in January 2008. As a result, a local Cheshire steering group is reviewing the existing Cheshire CFR schemes, and it will explore other opportunities to strengthen ambulance services in the region.

Local ambulance trusts, in consultation with other local emergency services, must decide whether they are happy for CFRs to operate under blue lights. That decision must comply with the Road Vehicle Lighting Regulations 1989, which state that blue lights can be used only by emergency vehicles used for

“fire brigade, ambulance or police purposes”.

In Nantwich, one CFR was using blue lights until 2008. That was one of only a small number of instances across the country of a CFR using blue lights. It was relatively rare, and I gather it was stopped because of the way in which that CFR was trained.

A demand for the wider use of blue lights must be treated with a great deal of caution. It is not only a matter of training, because although people can be trained, they also need to use blue lights regularly. They need their skills to be honed; they cannot be trained once and then use the skills intermittently. Ambulance and fire service crew and police officers use blue lights regularly. However, they do so with some risk; as we know from a number of incidents, using blue lights has risks for the public, so blue lights should be used with caution. People who use blue lights must not only be trained; they must be in a position to hone those skills through regular use.

I am grateful to the Minister for being generous in giving way. He has clearly read his brief and has tried to get to grips with as much of the detail as possible.

I do not want to stray into the minutiae, but the matter is extremely important. A CFR may not only have had the training to use a blue light but, as the Minister suggested, he may have honed those skills regularly over many years. Removing that blue light could reduce the number of call-outs to which the CFR responds—I gave the figures from my constituency of 120 in 2007 to 20 in 2009. That will not only reduce the possibility of saving lives, but result in exactly what the Minister does not want: it will prevent that skill from being used when appropriate and make it more difficult to reintroduce it later.

The hon. Gentleman makes a very sensible point, but misses the key one: it is not a matter of whether Ministers agree, but of whether the local ambulance trust, which has the delegated authority to make these decisions, agrees. I intervened on him earlier to get an idea of what he is looking for from me, as a Minister. I indicated that his party’s policy is to make the NHS much more independent of Ministers—to set up an NHS board and to keep it at arm’s length from ministerial intervention—and to ensure that Ministers have nothing to do with decisions made by ambulance trusts. We do not share that view on the extent of delegation.

The hon. Member for Eddisbury (Mr. O'Brien), to whom the hon. Gentleman has referred, is an advocate of Conservative Front-Bench policy—after all, he is himself a Conservative party Front-Bench spokesman. However, any of his constituents who intend to support him at the next election, which is a matter for them, must not assume that, if the Conservatives win, there will be a Minister who wants to do something about this situation. Indeed, the opposite will be case: the Conservative party will choose not get involved in any of these matters. We have said that ambulance trusts have to decide whether to allow CFRs to use blue lights—

Order. We must now move on to the next debate.