Hansard

In the debate on 22 May, a number of concerns were raised about the Scottish Ambulance Service. I undertook to investigate each and every one of them. Today, I want to report to Parliament on the actions that I intend to take to address those concerns.

First, I want to emphasise that the Scottish Ambulance Service performs well. The people who work in it do a good job and the people of Scotland should have confidence in it. The actions that I will announce today are intended to address concerns about specific issues in order that the Scottish Ambulance Service can continue to improve its performance and maintain public confidence. I also want to emphasise that my statement today is the start of a process. I intend to return to Parliament after the summer recess to update members on the various strands of work that I will announce today.

I intend to group my comments today under four broad headings that encompass the key concerns that were raised in the debate two weeks ago. They are: the leadership culture within the Scottish Ambulance Service and, in particular, allegations of bullying and harassment; the robustness of the data that underpin the apparent improvement in category A performance; issues relating to staffing, recruitment, overtime and associated concerns around, for example, shift cover and the single manning of ambulances that should be double crewed; and concerns about service redesign and the roll-out of the front-loaded model, in particular.

I will deal first with the leadership culture and allegations of bullying and harassment. I want to stress as strongly as I can that bullying and harassment have no place in Scotland's national health service. They will not be tolerated and any allegations will be treated with the utmost seriousness. The Scottish Government and the Scottish Ambulance Service received complaints about the leadership culture of the Scottish Ambulance Service in the days immediately prior to and following the debate on 22 May. As members would expect, the Scottish Government has been liaising very closely with the Scottish Ambulance Service on those matters.

However, where such allegations concern employees of an NHS board, it is imperative that they be investigated by the relevant board in its capacity as employer. I therefore welcome the decision of Bill Brackenridge, the board chair, to appoint an independent panel to investigate the allegations that have been made. I confirm that the panel will be headed by Ken Corsar, the chair of Lanarkshire NHS Board. As members are aware, the chief executive and director of operations of the Scottish Ambulance Service have taken voluntary leave of absence while the investigation is carried out. Pauline Moore, the Scottish Ambulance Service's finance director, has assumed the role of acting chief executive. I hope that members will be reassured, as I am, that the Scottish Ambulance Service has acted swiftly and correctly to investigate the allegations. It is right that we now await the outcome of the investigation. In the interests of fairness to all concerned, I do not intend to make any further comment on the matter at this time.

I turn to data. Doubts have been expressed about the reliability of the data that underpin the apparent improvement in category A performance. That is a very serious matter which, if not addressed, would strike at the very heart of patients' confidence. I have therefore instructed a comprehensive review of the performance information that is required for reporting on the category A target. The review will be led by a senior clinician and will include representation from the Scottish partnership forum, the Scottish Government health delivery directorate's improvement and support team, NHS National Services Scotland's information services division, and a director of operations from another NHS board. It will examine how Scottish Ambulance Service information systems are used to generate and report performance information to the Scottish Government and to determine whether the performance levels that were reported recently are accurate. I expect that work to be completed in a thorough and interrogative manner. I have asked for a report to be submitted to me and the Scottish Ambulance Service board by the end of July.

I turn to staffing and related issues. Concerns have been expressed about staffing levels, about the challenges that face the service in recruiting and retaining front-line ambulance crews, and about the practice of single manning of traditional accident and emergency units. Although those challenges are not confined to the Highlands, they are most acute in remote and rural areas. I would like to address the concern that Mary Scanlon raised in the debate on 22 May that a traffic light system for determining the allocation of overtime was in operation in the Highlands. As I have confirmed to Mary Scanlon in writing, although such a system was not in operation at that time, plans to introduce it from 26 May in the north-west of the north division had been developed. As I said in the debate, I consider such a system, which seeks to combine risk assessment with cost control, to be unacceptable, so I have instructed the Scottish Ambulance Service to cease that operational practice. It has confirmed to me that it has done so.

I have also made it clear to the Scottish Ambulance Service that it must take action to eliminate rostered single manning. The Scottish Government's policy is clear: traditional accident and emergency ambulances should be double crewed, with at least one member being a paramedic, unless there are exceptional circumstances. In too many instances, particularly in the Highlands, practice is not living up to that policy. That is not a new situation, but it must be addressed. I have therefore asked the Scottish Ambulance Service to provide me with an action plan demonstrating how it intends to achieve the elimination of single manning. I expect to receive that action plan by the end of this month.

In the meantime, although the service will continue to assess risk and deploy resources accordingly, I have made it clear that every effort should be made to cover all shifts and that budget controls should not determine decisions about whether to cover shifts. I have also asked the Scottish Ambulance Service to provide a status report on the wider challenges that it faces in managing recruitment and retention of staff, and to provide a plan for addressing those challenges. I expect that work to include any issues that arise from the agenda for change, some of which have been raised in Parliament previously.

I will address service redesign and, in particular, the roll-out of what is referred to as the front-loaded model. It might be useful if first I explain in more detail what is meant by "the front-loaded model". Rapid response vehicles have been a feature of the service's response to emergency calls, particularly category A calls, since 2002, when priority-based dispatch was introduced in Scotland. At that time, the resource—in most cases, sole-operating paramedics in cars—was identified as being able to respond more quickly than the traditional accident and emergency unit. When a rapid response vehicle was dispatched to an emergency call, a double-manned accident and emergency unit was dispatched at the same time or as soon as possible thereafter. The accident and emergency unit could then be stood down if, following triage of the patient's condition by the rapid response paramedic, the unit was considered unnecessary.

More recent developments in that model aim to get more paramedics to more patients more quickly, so that early treatment can begin and the patient's need for further support and/or transfer to hospital can be informed by early triage. The dispatch centre determines the most appropriate initial resource, based on the details that are supplied by the caller. In most cases, a double-crewed accident and emergency unit continues to be dispatched. However, for some cases, the fast paramedic response unit will be sent and the paramedic will determine at the scene whether dispatch of an accident and emergency unit is subsequently required.

From January 2008, 54 rapid response vehicles have been operating throughout Scotland under the new model, which has resulted in their being dispatched to deal with a wider range of conditions. Although care begins when the paramedic arrives, patients want, of course, to be assured that if transfer to hospital is required, it will happen quickly. The Scottish Ambulance Service currently has arrangements in place to ensure that that happens and will report back to me by the end of the month on how those arrangements are operating.

The front-loaded model is subject to the Scottish Ambulance Service's risk assessment and clinical governance procedures and has been successfully evaluated in England. During the debate on 22 May, I confirmed that the model was the subject of external evaluation in Lanarkshire. I have confidence in the model and believe that it will improve patients' experience, although I accept that more needs to be done to build public confidence in it. For that reason, I have asked the chief medical officer, Harry Burns, to commission an independent evaluation of the front-loaded model. The terms of reference for the evaluation will be agreed in partnership with the trade unions, and a copy will be placed in the Scottish Parliament information centre.

From comments that were made during the debate on 22 May, it was clear to me that the Scottish Ambulance Service needs to improve its communications with its staff and the public. The service will therefore develop a comprehensive stakeholder engagement plan, designed to give better information to MSPs, Ambulance Service staff and the wider public about service development. I hope that the commitment to an independent evaluation of the front-loaded operational model will help to reassure Parliament and the people of Scotland of our absolute commitment to securing an emergency service that delivers what is best for patients.

I will meet Bill Brackenridge and the board of the Scottish Ambulance Service on 2 July to follow up all the issues that I have outlined in my statement today. I believe that that will allow an appropriate period of time for the key issues to begin to be addressed. The meeting will also provide an opportunity for me to agree with the Ambulance Service the agenda for the formal and public annual review of the service, which will now be rearranged to take place in early autumn. That will, of course, provide an opportunity for public scrutiny and participation, and I hope that members of all parties will take the opportunity to attend the review. I am happy to give an undertaking that my office will circulate the date and venue as soon as they are agreed.

In the meantime, I hope that members will be reassured by the actions that are being taken to ensure that there is sound corporate and clinical governance within the Scottish Ambulance Service. I repeat that I take very seriously the concerns about service redesign, about challenges to the integrity of performance data, about staffing issues, and about allegations relating to the leadership culture. I take the opportunity to thank all members who have raised those issues, either during the debate on 22 May or on other occasions. The actions that I have announced today, less than two weeks after our debate on 22 May, are designed to address those concerns openly and honestly, to make improvements where we consider they are needed, and to build confidence in service changes that will improve patient care.

In closing, I again take the opportunity to place on record my thanks to all the people who work in the Scottish Ambulance Service, and to assure them categorically of my confidence in the job that they do.