Deputy First Minister and Health Secretary Nicola Sturgeon
Statement on the Scottish Ambulance Service
The Scottish Parliament
Wednesday, September 17, 2008
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Presiding Officer,
In the debate on May 22, a number of concerns were raised by members about the Scottish Ambulance Service. I undertook to investigate each and every one of them and on Wednesday June 4 I reported back to the Parliament on the actions which were being taken to address those concerns. I gave a commitment to come back to Parliament after the summer recess with an update on progress.
In the interests of consistency I intend to structure my update today around the same four issues that I covered on the 4th of June.
These were:
1. leadership culture
2. the accuracy and reliability of performance data
3. concerns about the use of fast response vehicles
4. staffing issues, with particular reference to single crewing
Presiding Officer,
The concerns around the leadership culture within the Scottish Ambulance Service were first brought to the attention of the Scottish Government and the Scottish Ambulance Service in May when formal complaints were made which included allegations of bullying and harassment.
The Ambulance Service Board asked Ken Corsar to chair an independent investigation. That investigation has been concluded and a report has been submitted to the Chair of the Scottish Ambulance Service. This remains a matter for the Board of the Scottish Ambulance Service but I am assured that due process has been, and will continue to be, followed. To ensure fairness to all concerned, I will not be making any further comment on this today.
Moving on to performance data, members will recall that concerns were raised about possible manipulation of performance data and a suspicion that the recent improvement in performance against the Category A target could be the result of such manipulation rather then genuine service improvement.
I confirmed that I had instructed a comprehensive review and audit of the performance information required for the reporting of this target. That review was led by Professor Peter Donnelly, the then Deputy Chief Medical Officer, and was supported by representatives from the Scottish Partnership Forum, the Scottish Government health directorates, ISD, and a director of operations from an English Ambulance Service Trust.
I have received Professor Donnelly's report and copies have now been made available to health spokespeople and placed in the Parliament's information centre.
I am pleased to advise members that the report finds no evidence of inappropriate data manipulation in the Scottish Ambulance Service. Professor Donnelly has emphasised that this conclusion is one to which he and the group attach a high degree of certainty. He has advised that the group received full co-operation from both staff and management of the Ambulance Service and benefited from an external data audit that confirmed the group's findings.
The report does, however, identify data handling, management and audit processes which were not sufficiently robust or which were not always being applied universally across the organisation.
It also pointed to the need for an external validation process to be developed and applied to the data produced by the Service before performance information is reported to the Scottish Government. The Scottish Ambulance Service agrees with these conclusions and is already taking action to address the recommendations.
Of course, the question then arises - if there has been no data manipulation, how has the service achieved the service improvements reflected in the category A performance figures?
Here the Group has concluded that there are credible explanations for the reported performance improvement. The report maps out an 18% category A performance gain made by the Service between December 2006 and May 2008 and describes the various operational areas where improvement has been made. These include:
• improvements in allocation and mobilisation times within the Emergency Medical Dispatch Centres and ambulance deployment points;
• improved basic performance flowing from investment of more resources and the better deployment of ambulances; and
• the introduction of auto reporting at scene.
I appreciate that this last factor - which the report estimates may account for around 4% of the reported performance improvement - does cause concern for members.
Due to the 200m tolerance of the vehicle location system, it is possible for an ambulance to be recorded as at scene slightly before they are actually there. It should be pointed out that this was also a possibility under the manual system and that auto reporting is used by all ambulance services.
Nevertheless the report rightly recommends that the Service identifies opportunities to refine the tolerance to further improve the accuracy of reporting.
I hope that this detailed report satisfies the concerns raised by members and reassures them that there has been no manipulation of performance data by the Scottish Ambulance Service. My officials will continue to work with the service to ensure the recommendations are taken forward and the required improvements in process are put in place.
Presiding Officer,
In my statement to Parliament on 4 June, I also confirmed that I had asked the Chief Medical Officer, Dr Harry Burns, to commission an independent evaluation of the Front Loaded Model. He tasked NHS Quality Improvement Scotland, under the guidance of a reference group, to undertake this review. The QIS review will be published on their website, and copies have been made available to members.
The report is clear that the use of fast response vehicles to respond to appropriate emergency calls is valid and that the principles of the front loaded model are sound. Therefore it recommends that the Scottish Ambulance Service should continue to develop the use of fast response vehicles as part of its service to meet the clinical needs of patients.
However, it makes a number of recommendations in relation to the more effective implementation of the key principles, including clinical governance, appropriate training and proactive engagement with the public, Ambulance Service staff and other parts of the health and emergency services.
Taking forward these recommendations will allow the Ambulance Service to deliver clinically effective, patient-centred care while addressing the concerns of staff about safety and governance.
In the interests of public assurance, however, I have asked the Chief Medical Officer to commission, in 6 months time, a further report on how the Scottish Ambulance Service is progressing in its utilisation of Fast Response Vehicles. This report will be published.
I have also made clear to the Scottish Ambulance Service my expectation that fast response vehicles should always be crewed by a paramedic, unless in exceptional circumstances.
In response, the Service has confirmed to me that, by the end of this calendar year, the rostered crewing of fast response vehicles by technicians will be eliminated.
Presiding Officer,
I will now turn to staffing and related issues.
Members are aware that the Ambulance Service faces a number of challenges flowing from the introduction of the new Agenda for Change pay, terms and conditions package. In particular, the implications of the new UK level agreement on how staff who work unsocial hours should be remunerated caused some difficulty for the Scottish Ambulance Service.
In addition, areas of the Agenda for Change agreement, such as the provisions on meal breaks and on call arrangements have presented real challenges for the Ambulance Service in Scotland.
Scottish Government officials have been discussing all of these issues with Ambulance Service management and unions and I am confident that all parties will, in the near future, be able to reach agreement on a way forward that is both right for the Ambulance Service and in the interests of patients. I will, of course, keep members updated.
Presiding Officer,
That leads me now to the final substantive issue I want to deal with today - the elimination of rostered single crewing of traditional accident and emergency ambulances. When I last reported on this issue to members, I made clear that I expected the Scottish Ambulance Service to take action to eliminate rostered single crewing. I asked it to provide me with an action plan demonstrating how it intended to achieve the elimination of single crewing on a sustainable basis.
I have now received this action plan and copies have been made available to members.
It is clear that delivery of the plan will require significant additional investment.
I am therefore delighted to announce today that the Scottish Government will provide an additional £4.7m to the Scottish Ambulance Service over this and the next two years.
This investment will support the recruitment and training of an additional 40 front-line staff into the North and South West Divisions of the Service.
This will result in a significant increase in the level of the relief capacity the Service is able to operate at and ensure that single crewing is eliminated in all but the most exceptional circumstances.
The Service has advised that realistically it will take some two years to have all of the staff required in post and trained. In the medium term, therefore, additional overtime resources will continue to be made available to keep incidents of single crewing to a minimum.
I am pleased to report that this investment is already making a difference. When I reported to parliament in June, there were regularly some 30 or more instances of single crewing every day in the North and South West divisions. That has already been reduced to single figures and, as it takes forward the action plan I have asked the Service to provide me with monthly reports on single crewing so that I, and members, can monitor progress.
I hope members will join me in welcoming the fact that routine single crewing of ambulances - for so many years an issue of deep concern in rural Scotland - is now being decisively addressed by this government.
Presiding Officer,
When I gave my statement to parliament in June I was very clear that it was important to reassure members and the public, about the service provided by the Scottish Ambulance Service. I hope that the progress I have set out today provides that reassurance.
From the work that has been ongoing over the summer, as well as the representations that have been made to me directly, it is evident that the ambulance service must continue to work hard to improve communication with staff, with other parts of the health service, and with the public.
In order to provide a modern ambulance service change will be inevitable and necessary, but that change must be managed at the right pace, with the full co-operation of staff and with the support and understanding of the public. To address this, the Scottish Ambulance Service has, over the summer, reviewed its arrangements for engagement with staff, patients and the wider public and has developed a comprehensive communications and engagement plan.
I know that in the last few weeks, all MSPs have been invited to meet their local ambulance managers to discuss issues of concern. I hope members will take up these opportunities.
I would like to place on record my sincere thanks to those who have worked so hard over the summer months to produce the reports that have been made available today, particularly given the challenging timescales that were set.
I hope that members will agree that swift action was taken in May to address the concerns raised about the Scottish Ambulance Service. It is now time to move on, and to support the Scottish Ambulance Service in tackling the challenging agenda of improvement that it now faces.
This Government remains committed to ensuring high quality, safe and effective ambulance services for all of Scotland and I am confident that the Scottish Ambulance Service will respond to the challenges it continues to face and deliver this for patients.