Hansard

In the debate on 22 May, members raised a number of concerns about the Scottish Ambulance Service. I undertook to investigate each and every one of those concerns and, on 4 June, I reported back to the Parliament on the actions that were being taken to address them. I gave a commitment then to come back to Parliament after the summer recess with a further update on progress.

In the interests of consistency, I intend to structure my update around the same four issues that I covered on 4 June. They were: leadership culture; the accuracy and reliability of performance data; concerns about the use of fast-response vehicles; and staffing issues, with particular reference to single crewing.

Concerns about the leadership culture in the Scottish Ambulance Service were first brought to the attention of the Scottish Government and the Scottish Ambulance Service in May, when formal complaints, including serious allegations of bullying and harassment, were made. At that time, the service's 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. It remains a matter for the service's board, but I am assured that due process has been and will continue to be followed. Members will understand why I will make no further comment on the issue today, to ensure fairness to all concerned.

Members will recall that concerns were expressed about possible manipulation of performance data and that there was a suspicion that the recent improvement in performance against the category A target might 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 that was required for reporting on the target. The review was led by Professor Peter Donnelly, the then deputy chief medical officer, and was supported by representatives of the Scottish partnership forum, the Scottish Government health directorates and ISD Scotland, and by a director of operations from an English ambulance service trust.

I have received Professor Donnelly's report; copies have now been made available to health spokespeople and placed in the Scottish Parliament 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 emphasised that he and the group attach a high degree of certainty to that conclusion. He advised that the group received full co-operation from both staff and management of the service and benefited from an external data audit that confirmed the group's findings.

However, the report identifies data-handling, management and audit processes that, in the group's opinion, were not sufficiently robust or were not always applied universally in the organisation. It points to the need for an external validation process to be developed and applied to the data that the service produces before performance information is reported to the Scottish Government. The Scottish Ambulance Service agrees with the report's conclusions and is already taking action to address the recommendations.

If there has been no data manipulation, how has the service achieved the service improvements that are reflected in the category A performance figures? The group concluded that there were credible explanations for the reported performance improvement. The report maps out an 18 per cent category A performance gain by the service between December 2006 and May 2008 and describes the various operational areas in which improvement has been made. The factors that it identifies include improvements in allocation and mobilisation times in 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 auto-reporting at scene—which, the report estimates, may account for about 4 per cent of the reported performance improvement—causes members some concern. Due to the 200m tolerance of the vehicle location system, it is possible for an ambulance to be recorded as at scene slightly before it is there. It should be pointed out that that was, and is, possible under the manual system and that auto-reporting is used by all ambulance services. Nevertheless, the report rightly recommends that the service identify opportunities to refine the system's tolerance to improve further the accuracy of reporting.

I hope that the detailed, thorough and extremely robust report that has been produced satisfies members' concerns 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 that all the report's recommendations are taken forward and that the required improvements in process are put in place quickly.

In my statement to Parliament on 4 June, I confirmed that I had asked the chief medical officer, Dr Harry Burns, to commission an independent evaluation of the front-loaded model. Dr Burns tasked NHS Quality Improvement Scotland, under the guidance of a reference group, to undertake the review. The QIS report has been published on its website, and copies have been made available to members.

The report is clear that the use of fast-response vehicles for responding to appropriate emergency calls is valid and that the principles of the front-loaded model are sound. 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. It also makes a number of recommendations on the more effective implementation of key principles, including clinical governance, appropriate training and proactive engagement with the public, Scottish Ambulance Service staff and other parts of the health and emergency services.

Taking forward all those recommendations will allow the Scottish 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 six months' time, a further report on how the service is progressing in its utilisation of fast-response vehicles. That report will of course be published, and I have no doubt that it will be the subject of debate by members of the Parliament.

I have made clear to the Scottish Ambulance Service my firm expectation that fast-response vehicles should always be crewed by a paramedic, unless there are 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.

I turn to staffing and related issues. Members are aware that the Scottish 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 United Kingdom-level agreement on how staff who work unsocial hours should be remunerated caused some difficulty for the service. In addition, some areas of the agenda for change agreement, such as the provisions on meal breaks and on-call arrangements, have presented real and significant challenges.

Scottish Government officials have been discussing all those issues with Scottish Ambulance Service management and trade unions. I am confident that all parties will, in the near future, be able to reach agreement on a way forward that is right for the Scottish Ambulance Service and its staff and which is also in the clear interests of patients. I will, of course, keep members fully updated on that set of issues.

That leads me to the final substantive issue that I wish to deal with today: the elimination of rostered single crewing of traditional accident and emergency ambulances. When I last reported on the issue to members, I made it 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 that action plan, and copies have been made available to members today.

It is clear that delivery of the action plan will require significant additional investment. I am therefore delighted to announce to Parliament that the Scottish Government will provide an additional £4.7 million to the Scottish Ambulance Service over this and the next two years. That investment will support the recruitment and training of an additional 40 front-line staff into the north and south-west divisions of the service. That will result in a significant increase in the relief capacity at which the service is able to operate, and it will ensure that single crewing is eliminated in all but the most exceptional and unforeseen circumstances. The service has advised that, realistically, it might take around two years to have all the staff who are required in post and fully trained. In the medium term, therefore, additional overtime resources will continue to be made available to keep the incidence of single crewing to a minimum.

I am pleased to report that that investment is already making a big difference. When I reported to the Parliament in June, there were 30 or more instances of single crewing every day in the north and south-west divisions. Such instances have already been reduced to single figures. I have asked the service to provide me with monthly reports on single crewing as it takes forward the action plan, so that I and members of the Scottish Parliament can monitor progress on an on-going basis. I hope that members of all parties will join me in welcoming the fact that routine single crewing of ambulances, which has been an issue of deep concern for many years, particularly in rural Scotland, is being decisively addressed by this Government.

When I gave my statement to the Parliament in June, I made it clear that it was important to reassure members and the public about the service that the Scottish Ambulance Service provides. I hope that the progress that I have set out begins to provide that reassurance. It is evident from the work that has been going on during summer and from the representations that have been made to me directly that the service must continue to work hard to improve communication with its staff, other parts of the health service, MSPs and the public.

Change is inevitable and necessary if we are to provide a modern ambulance service, but change must be managed at the right pace and with the full co-operation of staff and the support and understanding of the public. To address that, during summer the Scottish Ambulance Service reviewed its arrangements for engagement with staff, patients and the wider public and developed a comprehensive communications and engagement plan. In the past few weeks, all MSPs have been invited to meet their local ambulance managers to discuss issues of concern. I hope that all members will take up that opportunity.

I record my sincere thanks to the people who worked so hard during the summer to produce the reports that were made available today, particularly given the challenging timescales that were set for them. I hope that members agree that swift action was taken in May to address the concerns that had been raised about the Scottish Ambulance Service. It is time to move on and to support the service in tackling the challenging agenda of improvement that it faces.

The Government remains committed to ensuring high-quality, safe and effective ambulance services for the whole of Scotland. I am confident that the Scottish Ambulance Service will respond to the challenges that it continues to face and ensure that it delivers that high-quality service for all patients in Scotland.