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Let me deal with some of the issues that have cropped up in the debate. The hon. Member for Congleton asked whether St. Helena lacks the practical aspects of support while the delay is going on and suggested that there is a ban on DFID representatives visiting the island. I can say categorically that there is no such ban. The three-year assistance package that was negotiated with the Government of St. Helena and started in 2007
remains unchanged in respect of its commitment. To provide examples of how we are still investing in infrastructure, last year DFID provided £5 million of infrastructure investment, including £2.25 million for rock-fall protection works in Jamestown. This year, the Department is making available up to £4.5 million for infrastructure investment.
To ensure that St. Helena can benefit from the higher funding that has been agreed, DFID is supporting the recruitment of experienced engineering managers to improve capacity in the public works and services department on the island.
My right hon. Friend the Member for Oxford, East (Mr. Smith) proved to be a powerful advocate for his constituents and asked whether we would give a commitment to get on with the matter. The answer is yes; that is essential for us and for the Saints. He also asked whether we would take account of the long-term challenges facing the Saints on the island when we make our decision. The answer is yes, of course we will.
The hon. Member for Colchestermy friend from Colchesterasked why we cannot treat Saints as British subjects, and I addressed that in terms of the position of overseas territories. I regret his use of language in referring to the Governments decision being economic apartheid on the basis that Falkland islanders are white and Saints are not, and that that is why the Falklands received investment when St. Helena did not.
I think the hon. Gentleman used such language to reinforce his argument and that he does not believe it. But if he does, that is a mistake that many politicians make. The two facts may be correct, but that does not mean that they are causally related. There is a big difference between how the Government are dealing with the matter and how the South African regime operated apartheid.
Mr. Edward Timpson (Crewe and Nantwich) (Con): 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 callsthe 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 Commissions 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 lightwe cannot ignore the fact that its purpose is to ensure a speedy response to a life-saving situation to enhance the prospect of patient survivalit 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 writingwe have not received thatand 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 years 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.
there appears to have been no core principles underpinning the review.
the review of CFRs was not the subject of a written report to NWASs Board.
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.
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 services 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.
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.]
The Minister of State, Department of Health (Mr. Mike OBrien): 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. OBrien) is very clear that Ministers should not interfere with local truststhat 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 dointervene in this case?
Mr. Timpson: 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 Healths 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 targetsthey rightly are strictare 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 executives office, in order that all areas in the north-west may maintain a healthy confidence in their ambulance services 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 publics 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.
The Minister of State, Department of Health (Mr. Mike OBrien):
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. Gentlemans 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 Alife-threateningcalls 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 yearalmost 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 Governments 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.
Mr. Timpson: 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?
Mr. O'Brien: 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.
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