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Mr. Forsyth : There is an extra £500 for staff with paramedical skills. I acknowledge that the number of people in Scotland with those skills is small.
Mr. Sillars : Small? There are only eight.
Mr. Forsyth : Actually, there are 24.
Mr. Dennis Skinner (Bolsover) : Anyway, there are not very many.
Mr. Forsyth : The hon. Member for Govan did not mention the most important part of the offer. There is an offer of a joint review of the 1986 salary structure, without the preconditions on the scope or timing of the outcome. The offer provides the ambulance men with an opportunity to accept a 9 per cent. pay rise--and the small number, admittedly, with paramedical skills would receive the extra £500--and the opportunity in October to get a further increase. They would also be able to consider the 1986 arrangement and the work carried out by the
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emergency services and the patient transport services. All that could be done without preconditions. The ambulance men have the opportunity to accept a good pay increase and have negotiations at the same time. That is a fair and generous offer.Mr. McLeish : Is the Minister aware that the Government have tried to confuse the public? Will he tell the House and the listening public what the nature of the offer is over 12 months from April?
Mr. Forsyth : The hon. Gentleman did not really mean to ask me that. The nature of the offer over 12 months from 1 April 1989 is an increase of 9 per cent. That is a pretty reasonable offer. Mr. McLeish rose--
Mr. Forsyth : The hon. Gentleman wanted to know the nature of the offer from 1 April.
Mr. McLeish : The offer is over 18 months. What does that offer equate to over 12 months? How much cash, in percentage terms, will the ambulance men and women receive in the 12-month period from April to April, not over the 18 months?
Mr. Forsyth : The hon. Member for Fife, Central (Mr. McLeish) is an Opposition Front-Bench spokesman responsible, I believe, for industry, but he does not understand the nature of this offer. I will tell him again.
Over the 12 months from 1 April 1989 until 31 March 1990, the ambulance men will get a 9 per cent. pay increase that will be backdated to that date. Therefore, they will get a lump sum back payment. I hope that that is clear to the hon. Gentleman. From 1 April of this year until 30 September will also be 9 per cent., in so far as that 9 per cent. offer will extend over 18 months. On 1 October there will be an opportunity for a new arrangement to be reached.
Mr. Skinner : Will the Minister give way?
Mr. Forsyth : The hon. Member for Bolsover (Mr. Skinner), characteristically, understands that point only too well.
Mr. Skinner : Obviously, there is a gap between April and October, and that is the part that must be filled. We have 9 per cent. over 12 months and we have a gap of another six months. That makes 18 months. We have 9 per cent. They are paid over 18 months. That is roughly equivalent to 6.5 per cent. over 12 months.
Mr. Forsyth : The hon. Gentleman disappoints me. He will know that the original offer was 6.5 per cent. That offer was recommended to the ambulance men by their trade union negotiators.
Mr. Corbyn : They rejected it.
Mr. Forsyth : They rejected it. The trade union leaders believed that an offer of 6.5 per cent, was fair, and they recommended it to their members, but their members rejected it. Management, being reasonable and flexible, offered 9 per cent. over 12 months. The offer that is being made now is 9 per cent. until 30 September this year, with the opportunity then to discuss arrangements for the remainder of that year and also to review the structure of the 1986 settlement.
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Mr. Robin Cook (Livingston) : Three times the Minister has said--I have been counting--that the offer is 9 per cent. over 12 months. It is important that we know whether the Minister is developing the Government's offer. I do not believe that I give away any secrets about this, but the Ministery will probably be aware that, the last time staff and management met Duncan Nichol before Christmas, it was made plain to Duncan Nichol that, if the offer was made at 9 per cent. for 12 months, the staff side could settle.The Minister must be quite clear with the words that he is using. If he is prepared to say that it is a 9 per cent. offer over 12 months, this debate will have fulfilled a useful function and we can resolve the dispute this evening. The Minister must be quite honest and clear. Is that what he is saying? If he is not saying that, he should not mislead the House by using the very form of words that the staff side said that they would be willing to settle for.
Mr. Forsyth : The role that I am performing is educating the hon. Gentleman's colleagues about the nature of the increase in wages that ambulance men would enjoy in the period from 1 April 1989 to 31 March 1990, which would be a 9 per cent. increase. It is certainly true that the 9 per cent. that was offered is over an 18-month period, and it is certainly true that, having had their 9 per cent. increase, that would hold good until 30 September, when there would be an opportunity for further discussion about any increases subsequent to that.
It is quite wrong for the hon. Member for Bolsover to imply that this is some kind of confidence trick. If it is a confidence trick, it is an expensive one, because it involved finding £6 million of new money to fund it. That is a very real movement on the part of management.
Mr. Sillars : Will the Minister give way?
Mr. Forsyth : I shall not give way. I must make some progress. The improved offer that was made by management, which cost £6 million in 1989-90, was not even discussed by the main trade unions involved, but was rejected out of hand. The Government's position is that this dispute can be settled by negotiation and discussion. Management made an improved generous offer, which cost an extra £6 million, and it was not even discussed by the unions involved. Instead, they have persisted in taking industrial action that has caused untold misery to many elderly and sick people.
The hon. Member for Govan asked about the cost of the dispute. He asked how we can find the money to pay for the police, the Army and the voluntary services that are continuing to provide a service to the patient. The answer is simple : we have an obligation to try to maintain the emergency service, and that is what management have set out to do.
The hon. Gentleman suggested that simply allowing one group of workers in the Health Service to leapfrog the established arrangements for determining pay and conditions would incur no cost. I could not disagree with him more. Our package is fair and reasonable. It gives a 9 per cent. increase for the current year and offers scope for further discussion, and the trade unions should resume negotiations first.
The hon. Gentleman told us of his experience as a fireman and said that lives were saved by ambulance staff. He is right : lives often are saved by ambulance staff ; but
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they are saved also by doctors, nurses, technicians and many thousands of other dedicated people in the Health Service. All those groups have long since settled. Administrative and clerical staff settled for 6.25 per cent. from 1 April 1989, and ancillary staff settled for 6.5 per cent. from April 1989. Fewer than 1 per cent. of NHS employees have yet to settle. The bulk of them--dedicated professional people--have taken 6.5 per cent., which was the original offer recommended by the trade unions to the ambulance men.Mr. Robert Hughes : The Minister said that the difficulty was that any increased costs as a result of the increase in pay for ambulance personnel would have to come out of services, and that therefore other people within the Health Service would suffer. Is he saying that the cost of providing the police, for example, will come out of existing police budgets, that police budgets will have to suffer, and that those who depend on the police will suffer? Is he saying that the Government are providing new money to pay for the dispute and to pay for the police and other people involved? If that is what he is saying, is he not admitting that he is prepared to put dogma before the personal safety of patients, by finding extra money that could be paid to the ambulance personnel and get the dispute settled?
Mr. Forsyth : I take that as a plea by the hon. Gentleman that community charge payers in his constituency should meet the cost of the dispute. If the costs of the police were not to be met centrally by Government, they would be yet another charge on the community charge payer. I do not think that it would be right to expect the community charge payer to meet the costs of policing. Of course, Labour-controlled councils that are setting up alternative ambulance services will do so at the cost of the community charge payer. The hon. Member for Aberdeen, North (Mr. Hughes) will remember that the previous Labour Government got into a mess over pay in the Health Service. That is why they had to cut the hospital building programme by one quarter. That is why they ended up cutting nurses' pay by one quarter in real terms. Inflation got out of hand. Because this Government have ensured good management within the Health Service, we have seen a development of the Service, more patients being treated and new services being provided--as in the hon. Gentleman's own constituency, where cardiac services have been expanded, which he has welcomed.
When the bulk of the dedicated staff in the National Health Service have settled for 6.5 per cent., it cannot possibly be right to agree to make some provision for ambulance men that is outwith the normal methods of determining pay and conditions, simply because some of their members are prepared to put patient care at risk.
The hon. Member for Govan said that we should try to move towards arbitration. My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) asked whether he could give an example of that tried and tested procedure inside the Health Service. He was unable to do so, because there is no agreed provision for arbitration within Whitley. If we were to say to the ambulance men, "You can have arbitration," what about the other groups in the Health Service? What about the other groups within Whitley? What is the point of having Whitley if every group can simply disagree and move to arbitration?
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Mr. Forsyth : The hon. Gentleman says, "Why not?" The Health Service has well over 1 million employees, and 150,000 in Scotland. There would be chaos if every pay discussion went to arbitration. The system for determining ambulance pay and conditions within Whitley, which the hon. Gentleman repudiates, was satisfactory for several years when the settlements reached what was proposed by the ambulance men themselves.Mr. Robert Hughes : Does the Under-Secretary not understand that the Whitley council provisions come from an age-old process that was established before we faced the tremendous difficulties of inflation that have persisted for 20 or 30 years? In my view, therefore, the whole Whitley council procedure should be rejigged to look at these matters--
Mr. Sillars : And the Select Committee on Social Services said so.
Mr. Forsyth : I am sure that the whole House will be impressed by the strong statement made by the hon. Member for Aberdeen, North against nationally organised bargaining through councils such as the Whitley councils. I hope that it will not embarrass the hon. Gentleman if I make common cause with him in a few moments. Management must be responsible for pay. Pay in the National Health Service cannot be a matter for Government to determine, especially when 70 per cent. of its costs relate to pay. Management must determine the balance between service development and the amount that it can put forward for improving wages and salaries.
We are determined that there should be a better ambulance service in the future. We want to see more staff with paramedic skills. The hon. Member for Govan made great play of the fact that there are only 24 in Scotland. I should like to see a lot more--and our pay offer reflects that. It encourages people to acquire such skills. Although I approved a programme for increasing the numbers last November, it is now being held up by the dispute. We want the dispute to be resolved so that we can get on with establishing a service that has more paramedics.
We have increased spending on the Scottish ambulance service by 40 per cent. in real terms--that is even more than the amount by which we have increased expenditure on the Health Service overall, which has increased by one third.
Mr. Sillars rose --
Mr. Forsyth : I have been very generous to the hon. Gentleman already--
Mr. Sillars : Will the Minister give way on this point?
Mr. Forsyth : Very well, I give way again to the hon. Gentleman.
Mr. Sillars : I thank the Minister for giving way. On Friday evening, I met a constituent who is a qualified ambulance man. On 16 August 1988, he received a letter congratulating him on his interest in undertaking extended training to become a paramedic. He then received a letter in February 1989, telling him how well he had done and that he had passed the pre-test examination. Then he got a letter on 3 July 1989, telling him :
"Unfortunately, at the very last minute, our Professional Advisory Group have come into conflict with the Scottish Home and Health Department."
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My constituent wants to become what is known as a paramedic, but cannot because of the Minister's Department. That is why we have only eight paramedics in Scotland.Mr. Forsyth : I do not recall receiving any correspondence from the hon. Gentleman about that case. If it goes back to July 1989, he has taken a long time to raise the matter--
Mr. Sillars : I met the gentleman concerned on Friday.
Mr. Forsyth : If the gentleman came to see the hon. Gentleman on Friday and the correspondence goes back to July 1989, as I have just said, the fact remains that, in November last year, we decided to increase the training of paramedical staff, and that is now being held up. The hon. Gentleman is simply scoring points, when the real issue is whether there are opportunities for people to acquire paramedical skills. There are such opportunities, but they are being held up by the dispute, and the hon. Gentleman is not really helping to resolve it.
Mr. Dennis Turner (Wolverhampton, South-East) rose
Mr. Forsyth : I shall give way once more.
Mr. Turner : When will the Minister get round to telling us the cost of the dispute? The general public want to judge the Government on whether they have handled the dispute well or badly, as a result of the costs that the Government have incurred by continuing the dispute rather than settling it. Will the Minister please tell us the cost and set that against the pay increase that has been sought by the ambulance men?
Mr. Forsyth : If the hon. Gentleman had been here from the beginning of the debate, he might be more enlightened. He asks me about the cost of the dispute, but the cost is not measured only in money ; it is measured in all those elderly people who are not getting to their day centres or to their out-patient appointments, and in increased waiting lists. If the hon. Gentleman had been here to listen to the debate from the beginning, he would know that there is the opportunity for the ambulance men to get a 9 per cent. increase in pay and for discussions on the future of the service to continue.
The point that I was seeking to convey when the hon. Gentleman intervened was that the management must be in a position to work out the balance between pay and service developments. If I can speak for the Scottish ambulance service--I am amazed that a Scottish nationalist Member should complain that the Secretary of State for Scotland should have responsibility for replying to the debate
Mr. Forsyth : The hon. Gentleman should know that I speak for and on behalf of my right hon. and learned Friend the Secretary of State for Scotland. My right hon. and learned Friend has responsibility for the ambulance service in Scotland. I thought it amazing that the hon. Member for Govan should complain about that and suggest that it should be the responsibility of my right hon. Friend the Secretary of State for Health, whose responsibilities are south of the border. That is an unworthy complaint.
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I turn now to developments in the Scottish ambulance service, because I take it that the hon. Gentleman is interested in such developments in ScotlandMr. Sillars : And in the rest of the United Kingdom.
Mr. Forsyth : We plan to spend £6 million on a new radio communications system and £4.7 million on eight new communications centres. We are planning the computerisation of the ambulance service and are currently carrying out trials and pilot studies on the use of helicopters in Scotland. We are also planning a reduction in single manning.
Those developments are possible only if the management can judge what proportion of the resources should go into service development and what proportion into pay. If we were to listen to the hon. Member for Govan, all the resources would go on pay and there would be no service development. The first people to suffer would be the constituents of the hon. Member for Moray (Mrs. Ewing) and other people in rural areas, who will be the very ones to benefit from developments on single manning and from the use of helicopters to improve the emergency service.
Management must be able to judge the balance between pay and such developments. It would be wrong for Ministers to second-guess them or to force them to take decisions that are not in line with their view of the development of the service.
Mr. Turner : What about the cost of the police and the Army?
Mr. Forsyth : From a sedentary position, the hon. Member for Wolverhampton, South-East (Mr. Turner) is asking me about the police and the Army, and the hon. Member for Govan has already asked about parity for the ambulance service with the police and fire services. I advise the hon. Member for Livingston (Mr. Cook) that I do not recall the last Labour Government arguing the case for parity between the ambulance service and the police and fire services. I recall them setting up the Clegg commission, and I seem to remember that the Clegg commission rejected parity on the grounds that accident and emergency work was only a small proportion of the duties of ambulance staff. I must tell the hon. Member for Govan that the ambulance service is the emergency arm of the Health Service ; it is not the health arm of the emergency service--the point that my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) made earlier from a sedentary position.
It is right to say that the accident and emergency service accounts for only 10 per cent. of the journeys carried out by the ambulance service. Nothing has changed in the past 10 years to alter the arguments that were considered by the Clegg commission or the decision that was taken by the last Labour Government.
Mr. Holt : Will my hon. Friend reconsider what he has said about Clegg, and note that, when the Clegg commission investigated this matter, it did so at the fag end of the inquiry, and that no substantial evidence was brought to bear? There were anecdotal remarks by the management on that occasion, but neither side in the dispute has subsequently provided any statistical evidence to show how much time is spent on emergencies and how much is spent on routine matters.
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Mr. Forsyth : My hon. Friend has been helpful in telling the House his view of what Clegg said. However, that does not alter the facts of the matter, the position of the previous Labour Government or the fact that, subsequent to Clegg, in 1986, when there was a reorganisation of the position of ambulance men, that argument was not deployed or found to be significant.
Mr. Robin Cook : Perhaps I could help the Minister to refresh his memory of exactly what Clegg said on the matter. His comment on whether ambulance staff spent more of their time on emergency services is in paragraph 32 of the report. He said :
"The employers also made clear to us their view that there was a distinction to be drawn between ambulancemen involved in emergency work (which occupied, in their view, only 10 per cent. of all activity) and the ambulancemen involved in the routine movements of patients."
Is it not crystal clear from that statement that Clegg carried out no investigation and made no study of how much time was spent on emergency work? When the management quote Clegg, they merely quote back the echo of their own evidence to Clegg, which has never been substantiated.
Mr. Forsyth : The hon. Gentleman's party was in power and gave the terms of reference. If it was his party's policy that the ambulance men should have parity with the firemen and police, it was open to it to give them parity when it was in Government. If the hon. Gentleman seriously argues that Clegg would not have recommended parity if he thought that there was a case for it, I must take issue with him. It is not a claim but a matter of fact that 10 per cent. of journeys are for accident and emergency purposes.
Mr. Forsyth : It is a matter of fact. If the hon. Gentleman argues that small acknowledgements should be made of the accident and emergency service and its activities, the final offer made by management provides for that. It provides for a complete review. Instead of fanning the flames of the dispute, the hon. Gentleman should urge the trade unions to go back to the negotiating table and seize the opportunity to put their arguments.
Mr. Cook : The Minister has made an important and interesting statement. He has just said that it is a fact that one in 10 calls are emergency work. He must be aware that, when we have attempted to find evidence for that fact, we have been told in parliamentary answers that the information is not centrally available. He must also be aware that his colleague, the Secretary of State for Health, referred me to figures collected by York district health authority on behalf of the whole of England. Those figures show that, far from one in 10 calls being emergencies, the figure is one in five. Will the Minister please give us the evidence for the fact that he declaims?
Mr. Forsyth : I am happy to write to the hon. Gentleman-- [Interruption.] --setting out the basis on which the figures have been compounded. [ Hon. Members :-- "Tell us now."]. If the hon. Member for Livingston seriously challenges the position that aboutone in 10 of ambulance journeys are for emergency purposes, he will find himself at odds even with the ambulance men themselves. I do not know how many
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ambulance men he has spoken to recently. I spend quite a lot of time speaking to them. They tend to be outside most of my meetings these days. The fact is not in dispute.Even the hon. Gentleman must know that, in Scotland, the emergency service is organised on a separate basis for the non-emergency service in our urban areas. It is not a matter of great mystery how many patient journeys are emergency and how many non-emergency. If there is any variation in statistics, it is on the classification of journeys as either urgent or emergency journeys. The hon. Gentleman makes a non-point. If that is the best that he can do to undermine the Government's case that the trade unions should go back to the negotiating table, I look forward to his speech with interest. I certainly believe that pay negotiations in future should allow--this is where I agree with the hon. Member for Aberdeen, North, who, alas, has now left the Chamber--for more local flexibility to cover recruitment, retention and local needs. The inflexible national pay bargaining process which exists in many parts of the Health Service is increasingly nonsense. The ambulance service is a clear case where local management must have more responsibility and discretion in the future.
We want a settlement of the current dispute. We want a better accident and emergency service, with more paramedical staff. We are interested in local productivity deals which will release resources for better pay. On the table now is a 9 per cent. increase in pay and the offer of talks without preconditions for the future. I urge the trade unions to take us at our word and to restore the service which the public are entitled to expect.
5.4 pm
Mr. Robin Cook (Livingston) : It is a sign of the desperation of the Minister's party in Scotland that he expressed satisfaction that it has managed to squeeze past the Scottish National party in the latest opinion poll by an amount which is the same as the margin of sampling error of the opinion poll. I warn the hon. Gentleman that it will take only another couple of speeches like the one that we have just heard to take his party back into third place.
It is extremely revealing that it took us so long during the Minister's speech to drag out of him the fact that the Government's current offer is in truth an offer of 9 per cent. over 18 months. If the hon. Gentleman and his colleagues really believe that that is a fair, decent and honest offer, why did he go to such lengths to pretend that it was not 9 per cent. over 18 months? Of course he knows the truth. That is why it was so difficult for him to utter the words "9 per cent. over 18 months". It is well below the rate at which any group outside the Health Service and many groups within the Health Service have settled.
It is entertaining that the Minister was caught out claiming as facts matters on which he did not have a brief. Let me amplify the point that I made to him in my intervention : during the previous debate on the ambulance service, the Secretary of State for Health referred me to the figures from York, claiming that one in 10 calls to the ambulance service were emergency calls. He went on helpfully to say that emergency calls in the Health Service are defined to include moving people who are seriously ill straight to hospital on the advice of a doctor.
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I have consulted those figures. The figures collected in York show that the proportion of emergency patients as a proportion of all ambulance patients is 18.2 per cent. That is not one in 10, but almost one in five. The proportion of ambulance mileage spent on emergency calls is 28.6 per cent. of all ambulance calls. That is one in five of all patients and over one in four of ambulance miles. I ask again : where do the data come from to support the claim that one in 10 calls are to emergencies?Mr. Forsyth : The hon. Gentleman will appreciate that my responsibilities extend only to north of the border. He asked me to justify the figure of 10 per cent. The figures are as follows : there were 156,770 accident and emergency journeys, 176,956 urgent journeys, and 1,664,020 passenger transport service journeys out of a total of 1,997,746. That substantiates my point that one in 10 journeys were for emergencies. I hope that the hon. Gentleman will not feel that I have wasted the time of the House. Rather than go through the figures for all the health boards, perhaps he will be content if I write to him.
Mr. Cook : We shall be interested to see those figures. If the Government are sitting on such figures, I find it perplexing that they decline to answer questions on them.
I remind the Minister that we are debating a British dispute and a British motion. Even if the figures that he quoted are thrown in as the Scottish contribution to the United Kingdom figures collected by York, it is perfectly plain that one in five of all patients are carried in an emergency and over one in four of all ambulance miles are for emergency calls.
Even if the figure were one in 10--the statistics do not support that contention--that exceeds the proportion of time spent by the police on emergency calls. It is probably broadly comparable with the amount of time that the fire brigade spends on emergency calls. No one would dream of contesting the fact that the police and fire brigade are emergency services because they spend only 10 per cent. of their time on emergency calls. Why, then, should Conservative Members make it such a point of principle to deny that for ambulance staff?
What should cause most concern to the House, and undoubtedly will cause most concern and disappointment to the world outside, is that, during what was not a brief contribution to the debate, the Minister did not produce a single idea on how the stalemate would be broken. Not one new avenue of negotiation was opened up, not one new channel by which a second opinion might be taken. The only basis on which he held out the hope of settlement was if the staff side surrendered and accepted what has been on the table for the past three months. That was the Minister's sole contribution.
This is the sixth occasion when I have addressed the House on this issue. If, on the first occasion, at the end of November, I had been asked whether I would expect to address the House on the same matter at the end of February, I would have had difficulty crediting it. I still have difficulty in believing that even this Government have proved so stubborn, so dogmatic and so indifferent to public opinion that they have stonewalled the dispute for almost six months and not even met the staff side for more than two months.
My thoughts were unusually well expressed by the hon. Member for Harlow (Mr. Hayes), who, a fortnight ago in the London Evening Standard, was quoted as saying :
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"That a settlement is not even remotely within sight is remarkable, that the two sides are not even talking is obscene."Most of my hon. Friends and, I suspect, some Conservative Members would agree with the hon. Gentleman.
Mr. Michael Forsyth : The hon. Gentleman can have him, if he likes.
Mr. Cook : I rather suspect that, instead of having the hon. Member for Harlow, we shall have his seat at the next general election. Since that article, written only three weeks ago, three attempts have been made to bring the two sides together : by Church leaders, by an all-party group of Members of the other place and last week by the promptings of the chief ambulance officers--the very people whom Ministers keep telling us are the management of the ambulance service and should be allowed to get on with the process of negotiation themselves. Each of those three bids failed to bring about talks, because each time the management and the ministerial side refused to talk.
Mr. Sydney Bidwell (Ealing, Southall) : Does my hon. Friend agree that the great British public see this as the Government seeking to grind the ambulance workers into dust while they, by their generosity and widespread support for the ambulance workers' case, refuse to allow the Government to do so?
Mr. Cook : I will have comments to make about the degree of public support for the ambulance service later in my speech. It was notable that the Minister, although claiming to pay attention to opinion polls when they allowed the Tory party in Scotland to sneak into second place, ignored the opinion polls that related to the merits of the dispute.
My hon. Friend leads me to question why the public support the ambulance workers. We have all had opportunities to see ambulance staff at work, and over the past six months many of us have found ourselves in circumstances when we have witnessed their absence and the cost in human terms of that absence. It occurred to me a fortnight ago when I appeared on "Question Time". Ironically, shortly after we began discussing the ambulance dispute, a member of the audience took a severe heart attack and we had to interrupt the recording to accommodate the incident.
Hon. Members who have taken part in that programme will know that it is recorded in the Greenwood theatre, which is part of Guy's hospital. Although we were on the periphery of a major hospital complex, it was some time before a police ambulance arrived. When it did, it had no oxygen for the patient, who was breathless and in severe distress. The police had no training in resuscitation techniques--nor, to be fair to them, would it have been much value to them, because they had no resuscitation equipment. The only stretcher equipment that they had was an ambulance trolley, which was unsuitable for manoeuvring the patient up and down the steps. I am sorry to say that, when the patient reached Guy's hospital immediately round the corner, he was dead on arrival.
Many cases have involved a patient having to wait for much longer periods than usual. Only last week, there was an inquest into the death of an 86- year-old man who fell down the stairs at home and broke his pelvis and seven ribs
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