rose to move, That the Grand Committee do report to the House that it has considered the Civil Contingencies Act 2004 (Amendment of List of Responders) Order 2008.
The noble Baroness said: This order amends the Civil Contingencies Act 2004 to ensure that NHS trusts that provide ambulance services remain as category 1 responders if they attain NHS foundation trust status.
As noble Lords will be aware, the Civil Contingencies Act imposes a series of duties on local bodies, such as the police, fire brigades and local authorities, which are known as category 1 responders. Schedule 1 to the Act classifies NHS trusts as category 1 responders if they provide ambulance services, hospital accommodation and services in relation to accidents and emergencies, or public health services in Wales.
NHS foundation trusts, first established in England in 2004, have a status that is different from that of NHS trusts. Established as independent public benefit corporations, they are free from central government control and accountable to their local population. The Act classifies NHS foundation trusts as category 1 responders only if they provide,
“hospital accommodation and services in relation to accidents and emergencies”.
It does not take account of the potential for foundation trusts to provide ambulance services.
In June 2007, my predecessor announced that NHS trusts that provide ambulance services would be able to apply for foundation trust status from April 2009. In other words, none is in existence at the moment. Therefore, an amendment to Schedule 1 is required. This order serves to maintain the status quo should an ambulance trust become a foundation trust, ensuring that it will continue to be subject to the duties and responsibilities of category 1 responders.
As I am sure the Committee can appreciate, failing to amend the Act could, in the event of ambulance trusts attaining foundation trust status, result in these trusts no longer being legally responsible for the duties set out in the Civil Contingencies Act, and this, in turn, could have serious implications for patient safety and, indeed, the nation’s ability to respond to a national emergency. As such, I commend the order to the Committee. I beg to move.
Moved, That the Grand Committee do report to the House that it has considered the Civil Contingencies Act 2004 (Amendment of List of Responders) Order 2008. 30th Report from the Joint Committee on Statutory Instruments.—(Baroness Thornton.)
I thank the Minister for introducing the order, which is straightforward in its purpose and content. In broad terms, I take no issue with it. However, a few questions arise. Two of the defining features of a foundation trust are the greater degree of autonomy that it enjoys, as compared with a non-foundation trust, and the fact that it is not performance-managed by a strategic health authority. Given that these features apply, I am not clear about what drivers will exist to ensure that the care of patients who have been looked after by an ambulance foundation trust and then passed across to the A&E department of an acute NHS trust will be seamless and of a uniformly high standard.
I appreciate that foundation trusts have a duty of co-operation with the wider NHS, but that does not seem to be sufficient to guarantee that the interaction between an ambulance foundation trust and an acute trust will make the quality of the whole patient journey something that the ambulance trust makes one of its specific priorities. What matters to a foundation trust in terms of demonstrating that it has performed well is that it has met certain benchmarks relating to the care that it delivers. Whether or not it has facilitated good care delivered by another provider is not central to its mission.
On the other hand, what matters to a badly injured patient is not just the length of initial response time by the ambulance, or whether he is well looked after en route to A&E, but how long it takes him to access high-dependency care in hospital. Not for a minute do I wish to sound critical of ambulance crews, whose professionalism and dedication are not in question. I am just a little concerned that the systems and structures that we are setting up may not always work to the maximum extent possible in favour of good patient care, and that the greater insularity of an ambulance foundation trust may, in practice, not be wholly conducive to the delivery of optimum patient care along the entire patient pathway.
On a different issue, one of the other distinguishing features of foundation trusts is that they are fully subject to the tariff system. What progress is being made to apply a workable and credible tariff system to ambulance trusts, and how will this operate? Is it anticipated that there will be any change in target response times for ambulances, if and when ambulance trusts are overseen by Monitor? On a factual point, I should be glad to know how many ambulance trusts have indicated a wish to apply for foundation status.
Reverting to the content of the order, what steps are being taken to ensure that disaster preparedness training is being extended to these trusts, so that staff remain fully briefed and prepared for the worst? Will these civil contingencies duties be built into the functions of ambulance foundation trusts?
I thank the Minister for introducing the order and I, too, wish to home in on some of the same concerns as those expressed by the noble Earl, Lord Howe. I, too, am concerned about the fractured nature of the planning and management of emergency response that might arise from the granting of foundation trust status. For that reason, I want to ask the Minister the following question. It is right and sensible that foundation trusts and ambulance trusts should be an integral part of civil contingencies. Will this function be a factor upon which an application by an ambulance trust to be a foundation trust is assessed? Whether it is or not, will the preparedness and performance of an ambulance trust in the event of a disaster be part of the ongoing evaluation and maintenance of its trust status?
I thank both noble Lords for their questions, some of which I had anticipated. We spent a considerable amount of the early part of this year discussing the work of Monitor and the CQC. We commended Monitor for the admirable way in which it goes about its business and the way in which it ensures that foundation trusts carry out the job that they are supposed to do. That is what it and the CQC would do for ambulance foundation trusts. They would be under the same regulatory regime as other foundation trusts.
The noble Earl asked about payment for results. Payment for results in the sector is not a pre-requisite for the introduction of foundation trust status. On civil contingencies, that will be part of their terms and conditions of authorisation. It will be monitored and will be part of the granting of foundation trust status. They all intend to apply. Only one or two are on the stocks for early application.
On Question, Motion agreed to.