“(a) an NHS body in England,
(aa) a public health body in England.”
This amendment would extend the duty of collaboration on to all NHS and public health bodies, and not just the ambulance service.
With this it will be convenient to discuss the following:
Amendment 166, in clause 1, page 2, line 12, at end insert—
“(d) a local authority in England.”
This amendment would extend the duty of collaboration to local authorities in England.
Amendment 164, in clause 5, page 5, line 2, leave out “(a) an ambulance trust in England” and insert—
“(a) an NHS Body in England,
(aa) a public health body in England.”
This amendment is consequential to amendment 163.
Amendment 165, in clause 5, page 5, line 5, leave out subsection (4) and insert—
“(4) “NHS body” means anything defined as an NHS body by the National Health Services Act 2006.
(4A) “Public health body” means—
(a) Public Health England, or
(b) any NHS body or local authority carrying out public health functions.”
This amendment is consequential to amendment 163.
Amendment 167, in clause 5, page 5, line 15, at end insert—
“(5A) “Local Authority in England” means—
(a) a district council,
(b) a county council,
(c) a county borough council,
(d) a London borough council,
(e) the Greater London Authority,
(f) the Common Council of the City of London, or
(g) the Council of the Isles of Scilly.”
This amendment is consequential to amendment 166.
I am delighted to serve under your chairmanship, Mr Howarth. The amendments would place the duty to collaborate on all NHS and public health bodies, not just NHS ambulance trusts. They would increase the scope of collaboration agreements to include local authorities. We have tabled these amendments in recognition of the fact that much of the work undertaken by the fire service and, indeed, the police service has a much broader health and social impact than just the immediate emergency response. That needs to be recognised in the Bill.
I have no doubt that NHS ambulance trusts can and do benefit from collaborating with the police force and the fire service. In many parts of the country, the fire service plays a really important role in the first response to medical incidents. In Cornwall, the fire and rescue service works with the South Western Ambulance Service to respond to medical incidents when it can get to a location first. Firefighters have received medical training and know how to use defibrillators and carry out oxygen therapy. As we are all aware, Cornwall is a rural county with many isolated communities, which is why that sort of work is so important there. In fact, over the past three years, firefighter co-responders have made a total of 1,848 life-saving interventions, which is impressive.
Cornwall is far from alone in that activity. I have been to Lincolnshire and heard about the life-saving work of its co-responding scheme. Lincolnshire is another sprawling county with isolated communities, some of which lie close to fire stations—or rather, they are closer to fire stations than ambulance stations. I was told that the most common shout or call-out was to road traffic accidents in country lanes. Similar collaborative projects are going on up and down the country.
In addition, the fire and rescue service is playing an ever more important role in medical incidents. This support is particularly important in rural and semi-rural areas, where it is difficult to provide a comprehensive and rapid response service. The Somerset fire and rescue service attended 3,525 co- and first-responding incidents in 2012-13, equivalent to 41% of its road traffic collisions and special service calls.
English fire and rescue services attended 14,688 co- and first-responding medical incidents in 2012-13, including cardiac arrests, unconscious casualties, people with breathing difficulties and other serious conditions such as anaphylactic shock. The number of co- and first-responding incidents attended by the fire and rescue services is rising by about 10% or more each year, and is expected to treble to more than 30,000 by 2020. The number of category A ambulance incidents has more than doubled since 2002-03. The fire and rescue services have helped to achieve emergency response targets for an ever-increasing number of critical medical incidents.
It is clear that our two humanitarian services—fire and ambulance—are very effective when they work together, side by side. Without getting too far into the Bill, I have raised concerns before that police and crime commissioner takeovers of fire and rescue services may lead to fewer of these sorts of collaboration. The focus and energy of administrators will instead be devoted to responding to Whitehall’s agenda or the Government’s agenda of combining the police with fire services, and not necessarily working on the area of collaboration that will have the most positive benefits for the community.
Has the Minister carried out an assessment of the risk of a reduced collaboration between the ambulance and fire services, if mergers with PCCs go ahead and, if so, what mitigation has he put in place to try to prevent that? There is stark evidence that collaboration between ambulance services and the fire and rescue services saves lives. We cannot afford to see it crowded out by a top-down decision and Government imposition from Whitehall. It makes no sense, and it could take lives.
Having established the importance of collaboration between the blue light services, I will now argue that we are far from the limit of where collaboration can improve public services. In particular, the police force and fire service can and do play a vital role in early intervention and prevention programmes that aid public health, social care and social welfare. One of the many examples I could cite is the Springboard initiative carried out by Cheshire’s fire and rescue service. Firefighters on home visits go well beyond carrying out the traditional home safety assessment, which looks at fire alarms, electrical appliances, and the like. Instead, they use their time to spot the challenges that residents face regarding their health and well-being. Firefighters then report to the relevant parts of social services and other departments in local authorities, the health service, or, indeed, various local charities so that they can meet the needs that have been identified.
This is not insignificant. If hon. Members think about referrals such as those being made in their own area and multiply that by the number of fire and rescue services in the country, one can see the real value of making that first contact with vulnerable people, the preventive actions undertaken and, frankly, the savings for the NHS or social care in catching such issues early.
From May, the Cheshire scheme will focus on smoking cessation and alcohol consumption reduction—it is Lent and I have not had some for a while—as well as reducing hypertension and blood pressure, and informing residents about bowel cancer screening. That public health duty is carried out at the behest of the local authority, and it is innovative and important. The scheme makes a vast difference to the quality of life of many elderly residents in Cheshire, and there are 25,000 of those safe and well visits each year. That really shows what an asset public trust in the fire service can be, and how the subsequent reach in communities can help to improve public health and prevent harm.
In Gloucestershire, the fire and rescue service utilises public trust to aid Public Health England to prevent winter deaths from the cold. The Gloucestershire fire and rescue service is doing its bit to aid public health on its patch by installing thermometers in the homes of over-65s and referring elderly residents to their GP for a winter flu jab. That is just a local pilot at the moment but I look forward to hearing about the results as that type of scheme may become valuable in our quest to aid older constituents to stay healthy during the cold winter.
There are many more such schemes. I could talk about them today, but I am not going to because I hope that hon. Members will mention their own schemes. The schemes lead me to ask the Minister why the Bill limits collaboration agreements to ambulance trusts. Local authorities play a vital role in all the existing schemes and, under this Government, they have been given responsibility for public health, so why are they excluded from the new duty to collaborate? The provision, as written, seems arbitrary in scope. If we are to have a duty to collaborate—although I am rather surprised that the Minister thinks it necessary—why not use the duty as an opportunity to encourage more collaboration with more partners in more ventures such as the projects I described in Cheshire, Cornwall and Lincolnshire?
I say gently to the Minister—he knows that I like him quite a lot—that I fear that the decision to limit collaboration agreements to ambulance trusts speaks to a poverty of ambition for the fire service, which was, I am afraid, a hallmark of the previous Government. The Minister has been a firefighter and I am sure that he knows how much we can use a trusted set of skilled public workers in many different scenarios in the public health arena. Rather than using the Bill as an opportunity to recast and improve our public services to have the best and most resilient services possible, the Government seem driven only by the desire to pair with the police services in the hope that, by doing so, they will be able to find some immediate cuts.
The Government can see that savings can be made by sharing back-office functions in emergency response centres, so they make that their only legislative priority, but I fear that they simply cannot see past it. It is a missed opportunity and I genuinely do not understand why. Perhaps it is because preventive and early intervention work requires the investment of resources today to reap rewards in future. Perhaps it is because it is really difficult to quantify the savings that are made in this public health agenda. For example, we do not know how many older people who did not have the flu jab would have got influenza, found themselves in hospital and been unable to go back home. It is really difficult to quantify a “what if” scenario and offer it to the Treasury as a justification for the work that is done.
The Opposition believe in collaboration between the emergency services, but we recognise that services can benefit and improve when there is collaboration in as many areas as possible. The Government’s narrow vision does not seem to recognise vital preventive health work or its potential for public and preventive health improvement. If the Minister wants to convince the Opposition that these reforms are driven by the best interests of public services, and are not merely a fig leaf for hunting for spending cuts, I urge him to look at our amendments and broaden the scope of the collaboration agreements. He is a good man; I am sure that today we will have a good response from him to our very helpful interventions.
I fully understand where the shadow Minister is coming from. However, the Bill is concerned with emergency services. If we were looking at only fire and police and the so-called takeover for savings, which I obviously disagree with substantially, we would not have included the ambulance service. The ambulance service is specifically in the Bill in the duty of collaboration.
The shadow Minister and I could read all day about areas where collaboration has taken place. From my experience, it has not gone far enough in most cases and we need an awful lot more. Someone said to me when I was on a recent visit, “We carry defibrillators on front-line appliances these days, Minister.” That is fantastic news, but so does the cashier at Tesco and Sainsbury’s. We need to go much further than that. In some parts of the country we have done so, particularly in Hampshire, where the collaboration is such that a firefighter could not be distinguished from an ambulance technician, because they have those skills. We need to do an awful lot more of that.
I understand the shadow Minister’s point, but nothing in the Bill will stop the collaboration that is already taking place. As Fire Minister, as well as Police Minister, I am adamant that the fire service measures outcomes, although that is difficult. Where does the finance come from for that? Should that come out of the fire budget or the health and social services budget, and should they be paid? That is one of the big discussions at the moment.
The principle the shadow Minister talks of is right, but the Bill applies to the three emergency services. As a former shipping Minister, I would also like to have seen collaboration with the coastguard service, but that is probably a little step further on. Nothing in the Bill would prevent the sort of thing that the shadow Minister wants to continue to thrive and move on. With that in mind, sadly at the start of the Committee, I have to say I am sorry.
I am genuinely glad that the Minister and I seem to be on the same page, and that he is talking about evaluation and who is going to pay for it. I believe that the only way that we are collectively going to learn about how our services work together and the impact they can make is by evaluating them properly. With that in mind, I beg to ask leave to withdraw the amendment.