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The hon. Lady is right. The services should not be treated as being in one big pot. To be fair, many ambulance services separated their patient transport services--and they are now covered by separate contracts. However, she raises an important point. I hope that the Minister will say more about it.
I am confused about whether ambulances should get patients to hospital as quickly as possible or begin treatment at the scene. I have seen data that send conflicting signals about which approach gives patients the best chance of survival and recovery. It would be interesting if the Minister could update us about current thinking, and tell us what the indicators are from the latest available data and how she therefore expects ambulance services to develop. I suspect that the consolidation of hospitals into ever-larger units--certainly for specialist treatment--will continue. That is key to establishing patient confidence in the service.
People are conscious of where their nearest hospital is. However, anyone who looks into how the system works will quickly become aware that a patient is not necessarily taken to the nearest hospital. To use a Hampshire example, a patient suffering a head injury following a motor accident in Winchester will not be taken to the hospital in Winchester; he will be taken past its door to the hospital in Southampton because that is where head injuries can more properly and appropriately be dealt with. The matter is more complex than locating the nearest hospital and thinking of ambulances as a means of getting from A to B. Perhaps we have to take one step backwards in order to take two forward in thinking about the future configuration of ambulance services.
The hon. Member for Romsey has highlighted specific factors and issues relating to Hampshire, but in the process has touched on broader issues that relate to a much wider area. One such matter is the rationalisation and regionalisation of services in the south-east and the debate about the merger and reorganisation plans for ambulance services in the region, particularly the possibility of merger between the Surrey and Hampshire ambulance services. My right hon. Friend the Member for North-West Hampshire asked the Minister about that. I, too, should be grateful if she would tell us the current state of play.
My perception, as a Surrey Member of Parliament, is that Surrey is different from Hampshire in that its northern and eastern fringes are of a much more urban character. Its problems are more akin to those of the London ambulance service than to those of a rural one. Having said that, there is a degree of co-operation between Surrey and Hampshire ambulance services.
Mr. Howarth was in the Chamber earlier in the debate. He is not essentially involved in the discussion over Hampshire ambulance services. In his constituency, the majority of ambulance cover is provided by Surrey ambulance services under arrangements between the relevant health authorities. My hon. Friend believes that the arrangement works well.
Reference was made to the introduction of new technology for the Hampshire ambulance service. New technology often leads to teething troubles, but it is necessary to provide a modern ambulance service. It was, however, rather late coming to Hampshire, largely as a result of underfunding. Over the past two years, the Hampshire service has received only inflation-based increases, but demand--measured by the number of calls on the service--has risen by 8 per cent.
The Government set targets for the delivery of ambulance services and some money is passported through directly for the modernisation of ambulance services. The majority of the funding, however, comes from health authorities that face other huge pressures on their budgets. The health authorities that fund Hampshire Ambulance provide between 90 and 95 per cent. of the resources necessary to deliver the service. It is incumbent on the Government, when presenting and reiterating target figures, to address that issue. It is no good constantly reasserting the targets when adequate funding to meet them is clearly unavailable under current mechanisms.
Below-target response times are a widespread problem, but our debate on the issue has been confused. I shall clarify my understanding of the position and the Minister can correct me if I am wrong. Under the patients charter, the target for April 2003 is that for category A, life-threatening calls, an ambulance must arrive at the scene within eight minutes in 90 per cent. of cases. That information is set out in a bulletin from a website, which has just been printed out for me during our debate. That is my understanding of the Government's ultimate target. I assume that 75 per cent. is an interim target for April 2001.
The most recent published figures demonstrate that by April 2000, all ambulance trusts bar one--Staffordshire--failed to meet the 75 per cent. target. Another year has passed and the figures will not be published until June, but I hope that the Minister can provide some information about the percentage of ambulance trusts currently meeting the 75 per cent. eight-minute target.
I am not optimistic. The direction of travel has been backwards, not forwards. As I said, only Staffordshire had met the target by April 2000, and even that was a static performance in relation to the previous year. Several others in the list--Sussex, Dorset, Two Shires, Kent, Bedfordshire, Hertfordshire, Isle of Wight, Oxfordshire, Gloucestershire, Hereford and Worcestershire and West Country ambulance services--actually went backwards. Hampshire went from a 52.8 per cent. response performance in 1998-99 to 44.5 per cent. in 1999-2000. The Minister told us today that, by March 2001, it had fallen further to 43.62 per cent. To what does the Minister attribute that dismal decline in ambulance service performance? Why has her Government allowed the service to deteriorate to that level when, for example, in the last year of the previous Government, Hampshire ambulance service was achieving a 53.2 per cent. eight-minute response? Given the figures, will the Minister revise the targets for 2003 downwards to reflect reality or will she, as the Government have done with their other targets in the NHS plan, simply ignore what is happening in the real world and continue to spin the target figures, as though they were an achievable reality?
"raised people's expectations sky high and have not delivered." They are playing a dangerous game with public confidence in the NHS and the ambulance service in particular. The Government should look long and hard at performance, take proper advice on the realistic targets that can be met by 2003 and ensure that the figures being circulated in the public domain reflect them rather than some unachievable aspiration.