Air Ambulances

– in Westminster Hall at 4:00 pm on 27th February 2008.

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Photo of Ian Gibson Ian Gibson Labour, Norwich North 4:00 pm, 27th February 2008

We meet again, Mr. Bercow, under the fortunate circumstances of having a debate that can make a contribution to discussing a serious problem in the national health service.

On average, an air ambulance takes off every 10 minutes in this country, and air ambulances fly 365 days a year. To put it another way, there are seven air ambulances attending accidents and medical traumas every hour of every day. Medical trauma is defined simply as a physical injury that may result in permanent disability or death. There is a long history in war zones of helicopters taking troops to hospitals as quickly as possible, and there is the famous Royal Flying Doctor Service of Australia, which was the first national air ambulance programme and involved a pilot, a nurse and a doctor. The idea is not new; it has been around and is well tried, and it has been pretty effective and can be even more so.

Of course, helicopters are generally more manoeuvrable and flexible than they were and can land practically anywhere, including on many occasions in places that land ambulances cannot get to. They are used in all kinds of air rescue work. Emergency medical service helicopter programmes are established in the United States and in countries in western Europe such as Italy and Austria. Germany has a successful helicopter-based emergency service, the benefits of which have been well documented. A network of helicopters has evolved in the past 20 years and covers the whole of Germany, and the statistics show a dramatic improvement in patient outcomes, particularly in cases of trauma. I shall speak about that later.

The first civil helicopter-based EMS in Britain was opened in Cornwall in 1987, and one can see why: the beaches, inaccessible cliff tops, acres of moorland and farmland and roads that are congested, particularly in the summer, make the work of land vehicles more difficult and time-consuming. The distance to the major hospitals from many parts of Cornwall means that the air ambulance has become a vital, life-saving mode of transport.

The idea was picked up by our national medical institutions, and in 1988 a report by the Royal College of Surgeons recommended setting up a network of trauma centres geared specifically to dealing with the types of injury sustained in major accidents, to which patients would be flown directly by a national fleet of EMS helicopters. That recommendation has not come to fruition, but many counties and authorities have set up their own air ambulance programmes. After Cornwall came Kent, Scotland, the west midlands, London, Devon and many more. Nearly all the schemes are funded by charitable donations from the public, and whopping big donations they are, too.

In 2001 the East Anglia air ambulance operation was set up. It services Cambridgeshire, Norfolk and Suffolk, and in 2007 Bedfordshire was added, which I calculate means that it covers a remarkable 11 per cent. of the total area of England. Just the other day, Anglia One, as we call the helicopter, transferred a trauma-stricken patient who had been struck by a vehicle outside Gorleston, on the coast of Norfolk, to the Norfolk and Norwich hospital. A few hours later it responded to a driver trapped in his van after a collision on the Cromer road at Hevingham, providing support to fire crews at the scene; it then responded to another major collision—there are too many of them—on the M11 highway down Cambridge way. The medical crew attended from the helicopter and gave aid to a male driver and female passenger who had been trapped for some hours.

The helicopter is out four or five times a day. That does not always result in a patient being airlifted, because sometimes something happens to recover the situation. However, the speed of the air ambulance means that it can often arrive at an accident before any land ambulance could, assess and stabilise patients, work with the land crew when they arrive and establish whether anybody needs to be airlifted elsewhere. The speed of the helicopter is clearly paramount to its effectiveness.

Photo of David Taylor David Taylor Labour, North West Leicestershire

Air ambulances are certainly quick to respond to crises and accidents, but there is less responsiveness to the fundraisers and communities from which their funds are drawn. The service in Derbyshire almost collapsed last August, but it was restored and the Derbyshire, Leicestershire and Rutland service will recommence from East Midlands airport on 1 April. Does my hon. Friend believe that there ought to be better co-ordination between the various independent county air ambulances, and that the NHS could perhaps pay a little more towards them?

Photo of Ian Gibson Ian Gibson Labour, Norwich North

I thank my hon. Friend, who is spot on. I shall make the case for a proper inquiry to find out how the funding has been in the past few years, where the gaps are, how we can improve the situation and whether we can have co-ordination with the NHS. There is some interaction, as I shall describe, but more needs to be done because the service is essential and will be increasingly necessary to provide the national health service to which we aspire.

The Association of Air Ambulance Charities supports the work of the independent charities involved so that there is some co-ordination, and additional resources such as drugs, skills and suitable vehicles are part of that interaction. The association has 22 active helicopters in 16 of the 18 operational services in the UK, which are estimated to undertake 17,000 missions a year—no mean feat. At the moment, those missions are mainly in response to road traffic collisions and traumatic injuries, but that is changing. I shall say why in a minute.

Air ambulance finances, which, like cancer charities, are marvellously supported by a generous public, are said by some to be in a good state, unlike in the case that my hon. Friend David Taylor mentioned. However, the situation is not sustainable, because charities collect £25 million annually, or £70,000 a day, which is a large undertaking. A charity operating at that level obviously needs a lot of support and help. Money comes to the privately operated charities through public donations.

We have two helicopters in East Anglia, and the charity pays the pilots who serve the east and west of the vast territory that I described. People do not really understand the distances involved. In the west of the region, the charity must also fund attending paramedics on the helicopter out of its pocket; in the east, those costs are paid by the local NHS ambulance trust. There is good co-ordination and interchange among individuals who have learned from work on land ambulances how to conduct themselves with patients who have had accidents.

We must also consider the cost of consumable items such as drugs and medicine, some of which are funded by local NHS trusts, and of the important equipment that is being installed in air ambulances, such as defibrillators, monitoring machines and helicopter maintenance equipment. In many places, those costs are covered by charities. I do not wish to go through a freedom of information document that the Department has provided me with, but it includes a column showing whether, in various parts of the UK, the local NHS trust pays for the full cost of clinical staff. The answers are yes, yes, no, yes, no, yes, yes, yes, yes, no and yes. A column on whether they pay for drugs reads yes, yes, yes, no, yes, yes, yes, no, no, yes. You get the picture, Mr. Bercow—the situation varies depending on the trust involved.

Members will know of the important stories that have put the air ambulance in our living rooms and at the forefront of our awareness. In September 2006, the "Top Gear" presenter Richard Hammond was injured when he was going at 288 mph—not on the public highways, I add. A Yorkshire air ambulance crew stabilised him and transported him to Leeds hospital. He is quite a star and made a full recovery, and he and his friends were so thankful to the air ambulance crew for its service that they collected £400,000 to donate to it. That is a feature of the ambulance world, as of cancer care: celebrity interaction brings forward money.

Also as with cancer care, we have learned that there must be interaction with the state. I traditionally say that funding should be pound for pound, and I sometimes dream that that will happen. We should try to attain that and to get equality of funding from the state and the charity sector, through which people want to put in their efforts. The annual income of air ambulance charities is estimated at £25 million—quite big money and not bad for private charities, given that Government support has been minimal. That is a huge feat.

Over the years, there have been attempts to reform the service. Back in 1996, a critical report said that

"the health benefits are small, and there are limited circumstances in which...pre-hospital performance...can be improved."

The air ambulance service took that on board and improved its pre-hospital services. There are now better air ambulances, beds and facilities, and there are paramedics and a trained doctor on board who can treat patients at the scene of the accident or calamity. That is important and may mean the difference between life and death. Doctors sometimes carry out certain procedures at the scene of the accident, before they fly to hospital. That may lead to a small delay, but I have not heard of a helicopter going to the wrong hospital, whereas some land ambulances have to search around to find the right hospital because of communication problems.

There have been other important reports since 1996. One pointed out that 41 per cent. of patients attended by helicopter had their airways opened up at the scene by a doctor—a skilled and vital activity. None of them has been recorded as being taken to inappropriate hospitals. Patients picked up by ambulance often have blocked airways, which is not good for their survival. Secondary transfers were reduced in air ambulance cases, because those patients seem to get to the right hospitals; I shall come back to that point. We need a proper audit of what is happening with the air ambulance service right across the UK. It is not good enough to leave it to each ambulance trust or ambulance charity; we need some kind of co-ordinated activity. That could happen.

Strategic health authorities such as the East of England SHA are beginning to wake up regarding their strategies on injuries pertaining to specialist vascular surgery, coronary thrombosis or acute stroke management. Remember that our stroke policy is that patients must be taken to a stroke unit such as that at the Norfolk and Norwich university hospital in double-quick time to ensure that they survive. Given the geography of that area, only air ambulances can do that, so the scene is changing in terms of how such ambulances can make a real difference. Of course, there is also pre-hospital treatment and care.

We must also consider helipads and ensure that they are lit up. I cannot understand why the air ambulance service does not operate 24 hours a day. It could, given the right facilities and equipment. After all, accidents do not happen only during daylight hours; they also happen at night. That would help in traumatic injury cases.

Photo of David Taylor David Taylor Labour, North West Leicestershire

Problems with night flying usually relate to hazards such as power lines. The aggregate cost of the Derbyshire, Leicestershire and Rutland air ambulance service, at £1.3 million a year, is one twentieth of 1 per cent. of what the NHS spends in Derbyshire and Leicestershire—about £3 billion a year. Does my hon. Friend agree that the cost to the NHS would not break the bank, even if it were to meet more of the running costs?

Photo of Ian Gibson Ian Gibson Labour, Norwich North

I welcome my hon. Friend's intervention. I should also like to know how many people have survived because of that low-paid service. It is well worth the money. I invite the Minister to set up an inquiry into the whole service, across the UK, to see how it is performing with all the knowledge that has accrued over the years.

Many colleagues have attempted to support the air ambulance service and have received the usual replies, such as that it is all sorted out in the locality or that "We don't keep that data centrally". Those answers are familiar but long gone, in my mind, because we need to keep that data. Different air ambulance services record in different ways, and we need to unify the way in which we get data.

Sitting suspended for Divisions in the House.

On resuming

Photo of Ian Gibson Ian Gibson Labour, Norwich North 4:35 pm, 27th February 2008

Let me try to tie it all up in the last couple of minutes. I would like to encourage trusts to consider funding all the clinical costs of every air ambulance service in the United Kingdom and ensuring that every unit has a pre-hospital care doctor and a paramedic on board, greatly to improve trauma-patient outcomes. I believe that that is possible. Furthermore, if air ambulances are to become an integral part of our national health strategy, we must make sure that every regional hospital has a lit helipad to facilitate safe, speedy inter-hospital transfers.

Lastly, if there are no centrally held data to audit, we must incorporate a national guideline for registering air ambulance records and statistics. We need a good compact to start with between trusts and air ambulance services, and the Department of Health could facilitate that. This service plays an integral role in our health services. It should be recognised and supported and should work throughout the UK. It would be of benefit in respect of vehicular accidents and traumatic events.

I am not talking about a Northern Rock situation—another place and time, perhaps—and I do not advocate nationalisation of the whole service: quite the opposite. I am not asking the Government to step in and save a dying industry, but to help a productive sector survive and thrive. It is doing quite well, but it is still somewhat short of its potential and time is coming up on us fast. Our Government must invest in this life-saving opportunity. I looked forward to the Minister's saying yes.

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health 4:37 pm, 27th February 2008

I congratulate my hon. Friend Dr. Gibson on securing this debate and thank him for raising a subject that is close to the hearts of many involved in the delivery of health care. My county is not dissimilar to my hon. Friend's: it is rural and sparsely populated, with Dartmoor in the middle of it, which means that it is an appropriate county for an air ambulance to work in. I am pleased to say that we have one, too.

We value the work that air ambulances do and the services that they deliver to patients. They have, as my hon. Friend said, demonstrated time and again that they can make a difference, particularly in emergency care and where road access is a problem and where they can get patients to hospital, and between hospitals, faster.

As I am sure that my hon. Friend will appreciate, as somebody who takes a close interest in health matters, particularly funding, we are taking fewer funding decisions nationally for the health service these days as we give more autonomy to local health trusts to decide on their own spending priorities. We have to take into account the public benefit gained from any increase in expenditure. We have to start by considering where the resources that are made available for the health service will make most difference.

I am sure that my hon. Friend will also be aware that it was this Government, in 2002, who issued guidance to trusts saying that they should support the clinical staff on air ambulances. I am concerned to hear about the list of trusts that he mentioned earlier where that is not so. I was aware of one from my own research, but I will go back and check that and, if necessary, reiterate the guidance that we gave in 2002. Of course, no statutory support for air ambulances had been provided by the previous Government. The increase in funding by this Government was part of a general package of increased funding for ambulance and emergency services since 1997 of 135 per cent. However, the current advice available to me on the cost-benefit for patients in terms of lives saved and improvements in care would not currently justify extending statutory funding for air ambulances in further areas. However, my hon. Friend identified one or two areas where that could change. For example, if emergency and particularly trauma services were reorganised in the way that he suggests with fewer major trauma centres and greater distances between them, that equation could change. It could also perhaps change more easily and more effectively in the short term with better co-ordination, and he addressed that in his speech.

Where air ambulance services are targeted more effectively—my hon. Friend referred particularly to major trauma, or blunt trauma, as it is called—the research that we have commissioned from Sheffield university, about which I can write to him with the details, showed that if the average air ambulance service in the country saved four trauma victims' lives a year, it would change the balance of benefit in terms of public funding. It might be possible to achieve that benefit with better targeting. However, at the moment, there are still quite a lot of air ambulance dispatches for far more minor cases, and the economics do not stack up. Between just 1 and 2 per cent. of overall ambulance responses are conducted by air ambulances in areas that have them.

My hon. Friend also highlighted a number of areas where there are still drawbacks in using air ambulances. He mentioned the lack of landing pads at hospitals, so that air ambulances must sometimes land some distance away from the hospital with subsequent road transfer of the patient. Night flying is another issue, and my hon. Friend David Taylor was right in saying that there are still considerable safety obstacles for air ambulances flying at night. There are also medical reasons why patients with certain injuries and conditions—for example, maternity patients, neonates, and some head trauma patients—should not be transported by air ambulance.

There are a number of challenges. They are not insurmountable for the air ambulance services and charities, but I wanted to outline them to try to explain to my hon. Friend the Member for Norwich, North that although we warmly welcome the work of air ambulances, based on the current NICE-based calculations—he is on the record as supporting that institution—it would not be worth spending more taxpayers' money than at present on air ambulances. However, that does not mean that we should not encourage trusts to follow our guidance. Nor does it mean that we should not encourage better co-ordination, which is variable and patchy throughout the country between statutory trusts and air ambulance services.

My hon. Friend may not be aware of the review of co-ordination between the NHS ambulance trusts and air ambulance, which is due to report in May, and whether that co-ordination could be better and allow more effective targeting with the sort of cost-benefits to which he referred.

I want to put on the record a couple of other figures that my hon. Friend might be interested in. The Sheffield university research to which I referred found that the average cost of an air ambulance journey was around £1,100, compared with the average cost of a land ambulance of between £139 and £231, so the cost multiple is between fivefold and tenfold.

Photo of Ian Gibson Ian Gibson Labour, Norwich North

Was the Sheffield inquiry in 1996?

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

No, I am helpfully informed that it was in 2003. It is a good job that I can lip-read. It was around the same time that we extended public funding that we recommended to local trusts that the salary costs of the clinical staff who crew air ambulances should be met from NHS funds. However, as with everything in the health service, we keep these matters under review.

My hon. Friend knows that there are enormous pressures on the Government constantly to issue diktats from the centre about national framework standards and national priorities. At the same time, we are criticised for having too many targets and too many centrally determined service standards and requirements. The journey of travel is away from that to more devolved decision making at strategic health authority and primary care trust levels. It is important that the PCTs take note of our guidance on their relationships and their funding for their air ambulances, and that they work more effectively and in a more co-ordinated way with them to ensure that existing services are more joined up.

Photo of David Taylor David Taylor Labour, North West Leicestershire

To put the comparative costs of road vehicles and air ambulances into context, will the Minister say whether the cost that he quoted factored in the earlier arrival of assistance, and the improved outcomes that routinely emerge from the use of air ambulances?

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

I think that I am right in saying that the Sheffield university research came up with the comparison in terms of response times, but it also took into account what would be needed, taking those response times into consideration, to change the policy for supporting air ambulances with statutory funding, which goes back to my point about four avoidable deaths saved per year. The Sheffield study found that if, taking everything into account, an air ambulance could save four or more blunt trauma patients each year, the cost per quality-adjusted life year is, as I am sure my hon. Friends who take an interest in health matters will be aware, likely to be acceptable based on NICE thresholds. The Sheffield study also found that that would require air ambulances to be better targeted than at present.

Photo of Ian Gibson Ian Gibson Labour, Norwich North

Does the Minister accept that there may be not just trauma savings, but savings on patients with strokes, thrombosis and so on? That would save a lot of money. My earlier point was that some things are not recorded. An air ambulance may pick up a patient and drop them off, and that is the end of the matter. They do not always say what the cause and effect of treatment was.

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

My hon. Friend is absolutely right that the way in which we deal with stroke patients needs a great deal of attention, and I am sure that he will be aware that we recently published an updated stroke strategy. He is right in saying that advances in technology and medical knowledge show that in many parts of the country we have not dealt with stroke victims in the most effective way. It is important to get to patients quickly, to get the right drugs to those who have suffered a certain type of stroke, and to do what can be done in an ambulance environment, but while getting them to a specialist stroke centre as quickly as possible. There may be models in future under which specialist stroke centres may benefit from the quick transportation that he is outlining, but that is not currently the case.

I am advised that the best advantage of air ambulances is for serious blunt trauma cases, which is where the main benefit lies. We believe that services have matured and improved since the research to which I referred, and we look forward to any changes and suggestions from hon. Friends on the contribution that air ambulances can make. We value their contribution, and we believe that they should work more closely with the service and with charities to target and deliver the care that patients need. We believe that they have a good future, supported as they are by taxpayers and the fantastic contributions that enthusiasts and volunteers make.