Plenary, 04 Jun 2008

Meeting date: Wednesday, June 4, 2008

Official Report 411KB pdf

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Scottish Ambulance Service

The next item of business is a statement by Nicola Sturgeon on the Scottish Ambulance Service. The cabinet secretary will, of course, take questions at the end of her 15-minute statement, so there should be no interventions or interruptions during it.

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.

The cabinet secretary will now take questions on the issues that were raised in her statement. We have around 30 minutes for such questions, after which we must move to the next item of business, which is very tightly subscribed.

I remind members that all contributions should be made through the chair. That means that members should refer to other members by their preferred name or by their title.

Thank you, Presiding Officer—I will do my very best, I promise. I thank the cabinet secretary for advance copy of the statement.

Cabinet secretary, you will be aware that Labour brought these issues to the Parliament on 22 May because concerns throughout Scotland were so serious that they demanded immediate attention. I begin today by stating categorically that the Labour Party recognises the contribution of ambulance staff in Scotland. The respect that they receive throughout the country is well deserved.

When Labour brought the debate to Parliament, we raised concerns about fewer ambulances being on the streets of Scotland; about clinical safety being compromised in order to meet targets; about basic shifts not being covered because of financial pressures; about ambulances not being cleaned; about staff being pushed to the limit; and about a culture of bullying and harassment that was beginning to emerge.

I welcome the statement—the actions that are outlined in it are exactly what we called for in the debate on 22 May. I will, however, leave to one side that we were told one week ago that they were not necessary, because I want to acknowledge the progress that has been made and the element of independence that has been introduced to the myriad investigations that are under way. Cabinet secretary, I hope that you will keep your word and continue to keep Parliament informed because of members' interest in the issue. I suggest that you meet the party spokespeople before the end of recess because we would like to keep abreast of the detail of the independent inquiries that are under way.

I will ask you a question that I asked the First Minister recently. Are there fewer double-crewed ambulances on the streets of Scotland this year than there were last year and the year before? You also referred in your statement to who determines the dispatch of a double-crewed ambulance. I think you appreciate the scale of the concern throughout Scotland on this issue, and I presume that all aspects and operations of the model will be covered by the Harry Burns investigation.

In the past, I have raised with you my constituency interest in the issue, which is a deeply tragic case involving the death of a young man. The case was highlighted extensively by the Daily Record. At the time, I asked for an inquiry into the circumstances of the case but you rejected my request. I ask you to reconsider that, to hear my constituent's representations and to ensure that at the very least there is some independent assessment of the circumstances of the case.

What is the scale in real terms of the efficiencies that are required of the Scottish Ambulance Service by the Scottish National Party Government? What impact is that having on ambulance services in Scotland?

I thank Margaret Curran for her questions. I acknowledge that Labour raised those issues two weeks ago. Members of all parties have raised them and I thank all of them for doing so. I hope that Margaret Curran accepts that I have, as I said I would in the statement two weeks ago, acted swiftly to address the concerns. If it is the desire of party spokespeople to meet before the summer recess to discuss progress, I will be more than happy to arrange such a meeting. I am sure that such a meeting would have a useful part to play in ensuring that members and the wider public are kept informed.

I confirm to Margaret Curran that all aspects of the operation of the front-loaded model will be covered by the independent evaluation that will be commissioned by the chief medical officer. I stress again that I have confidence in the model. It has been operating in other parts of the United Kingdom for much longer than it has in Scotland, and with quite impressive results. It is already subject to the clinical governance procedures of the Scottish Ambulance Service, which are in turn reviewed by NHS Quality Improvement Scotland. Although I have confidence in the potential of the model to improve the service for patients, I understand that it is not enough for me or the Scottish Ambulance Service to have confidence in it; the public must have confidence in it, too, which is why I have announced the actions that I outlined in my statement.

Margaret Curran said that there are

"fewer ambulances … on the streets of Scotland."

I draw her attention to the fact that there are more emergency ambulances on the streets of Scotland now than at any time since 2003. That important point should be placed on the record. It is right that the Scottish Ambulance Service continues to ensure that the mix of those vehicles is right. Margaret Curran is correct to say that there are slightly fewer accident and emergency units as part of that fleet, but the reason is that the Scottish Ambulance Service has acted to increase the number of mid-tier ambulances that are more appropriate for activities such as transferring patients between hospitals or to hospitals from general practitioner referrals. That allows the Ambulance Service to make better use of accident and emergency units. Let us be clear: there are more emergency ambulances. However, the Ambulance Service has an obligation to ensure that it has the correct mix of vehicles.

Like every other NHS board and every other part of the public sector in Scotland, the Ambulance Service has been asked to deliver efficiency savings of 2 per cent. That is 1 percentage point less than the figure that Wendy Alexander wanted the public sector to meet. We are absolutely clear that efficiency savings are exactly that. They are not efficiency savings if they reduce service quality, which is why I made it clear in my statement that I do not expect shifts to be not covered for budgetary reasons.

Margaret Curran also mentioned a difficult constituency case. I understand—I am sure that she will correct me if I am wrong—that she has had the opportunity to listen to the recording of the conversation that took place between the ambulance staff member and the dispatch centre control staff. I am more than happy to meet her constituents, if that would be helpful, and to consider any further representations that are made. However, I emphasise that the decisions that were taken in that case were taken to protect the safety of Ambulance Service staff. I merely speculate when I say that had different decisions been taken and had the staff member come to harm, members would rightly call for an inquiry into that, as well. All I am saying is that difficult judgments need to be made, but I am more than happy to discuss them further.

I remind all remaining members that making contributions through the chair means not calling other members "you".

I thank the Cabinet Secretary for Health and Wellbeing for a copy of her statement and I place on record the Conservatives' recognition of the excellent work that ambulance crews and staff do. I acknowledge the Government's commitment to the serious issues that were outlined in the statement and which have been raised previously by MSPs of different parties. I am also pleased that single manning is being dealt with and that the Ambulance Service is being listened to as it expresses its concerns for the people whom it serves.

Will the health secretary consider opportunities to train to paramedic level the ambulance technicians whose salaries were cut by £3,000 a year as a result of agenda for change? On the independent evaluation of the front-loaded model, will she now properly consult the staff members who have serious reservations about the model but who have felt unable to express their opinions on service changes for fear of repercussions from senior management?

I thank her courteously for the letter that I received from her last week and the explanation that she gave today on the traffic light system, which I raised last week. I suggest that she should ensure that local ambulance services keep MSPs fully informed of change. That is crucial, particularly given that three meetings that Highland MSPs were to have with the Scottish Ambulance Service in recent months have been cancelled and August or September has been suggested for a replacement date.

I thank Mary Scanlon for her acknowledgement of the action that is being taken on single manning. The problem has been with us for many years, but I think we all agree that it must be addressed. I also thank her for her gracious acknowledgement of the letter on the traffic light system and the explanation for it.

She raises an important point about ambulance technicians. The fact is that they are much more skilled today than they were previously. The Ambulance Service is working to upskill them to paramedic level. Another issue that was raised in the debate was the rostering of technicians on rapid response vehicles. I have made it clear to the Ambulance Service that it must work to eliminate that; part of the solution will be for it to train as many technicians as possible to paramedic level.

The point about staff involvement was well made. I hope that I made clear in my statement the importance that I attach to it. The terms of reference for the independent evaluation of the front-loaded model will be drawn up in partnership with the trade unions—I expect them to be integral to that. I expect all parts of the NHS to honour the principles of partnership working, which means involving staff at the earliest stages in service development and policy changes. That is a model of working to which I am committed and I expect all members of NHS management to adhere to it.

I am not aware of the detail of Mary Scanlon's point about cancellation of meetings. However, I will ask the Ambulance Service to ensure, when it draws up the engagement plan about which I talked, that its engagement with elected representatives, as well as with staff and the wider public, is up to scratch, as we all expect it to be.

My recollection of the conclusion of the debate on 22 May was that it was, in fact, a Liberal Democrat amendment, calling for a statement from the cabinet secretary, that was approved by the Parliament. It would be entirely churlish of me not to thank the cabinet secretary for coming to the chamber so quickly with her statement and for providing copies of it in advance. It would be equally churlish not to recognise that the cabinet secretary has addressed, or is in the course of addressing, or has set in place steps to address, almost all the issues that were raised in the debate last month, which is welcome. I hope that, equally, the cabinet secretary will acknowledge that, although the Scottish Ambulance Service performs well and those who work for it do a good job, the issues that we have been discussing are important. The breadth and range of her statement indicate that a number of them need to be addressed.

I have two questions. First, I accept wholly what the cabinet secretary said about front loading being tested elsewhere. I hope that, in asking for an inquiry, she will not prescribe it narrowly, such that it precludes addressing relationships and staffing. If, as the cabinet secretary has admitted, a number of rostering issues have developed that are not acceptable to her and are not in line with policy, that could easily undermine the delivery of front loading. I hope that the specification that Harry Burns receives will cover those issues.

Secondly, I refer again to a matter that it is important to raise in the public interest—safety and ambulance journey times. I do not wish to go on and on about it, but I continue to believe that the cabinet secretary is required to give the public assurance on some of the statements that were made in good faith by Professor Walker in his report on Ayr hospital, which implied that extended journeys might not be safe. As I requested during the debate on 22 May, we require some public assurance on the matter.

I thank Ross Finnie for those questions. Before this descends into a competition between Labour and the Liberal Democrats as to who is responsible for today's statement, I will try to build some consensus by saying that this is an example of Parliament collectively doing its job properly, and we should perhaps all take some credit.

Ross Finnie rightly says that the issues that the statement raises are important. I hope that I conveyed during last month's debate the fact that I take them seriously. If anybody was left in any doubt about that, I hope that I have demonstrated by coming to the chamber with a statement so soon after that debate and by addressing the issues so comprehensively that I take all those issues seriously. Public confidence in any part of the NHS is paramount; in emergency services, it is particularly important. I will do everything in my power to ensure that public confidence is not compromised in any way.

I turn to the two questions that Ross Finnie asked. First, on the interrelationship between front loading and staffing issues, there is a relationship, and some overlap, between the different work streams that I have announced today. I will consider Ross Finnie's point when we draw up the terms of reference for the independent evaluation to reflect the need for it to assess the safety of the front-loading model and to provide reassurance that it is not being used inappropriately because of other staffing pressures.

Secondly, on Andrew Walker's report, the debate is perhaps for another day, although I appreciate the importance of Ross Finnie's point. I do not think that Andrew Walker was saying that extended ambulance journey times are dangerous and put lives at risk in all circumstances; he was making a point in the particular context of Ayr and Monklands hospitals.

Our discussion of the front-loaded system is not specifically about journey times to hospital; it is about the importance of getting paramedics to patients as quickly as possible and, in many cases, being able to see and treat patients without transfer to hospital. However, I acknowledge Ross Finnie's points and I am more than happy to return to them in future.

We now come to questions from back benchers. More people wish to ask questions than I can possibly fit in, so in order to allow in as many as possible, I make a plea for no speeches, no preambles, one question per member and answers that are as brief as possible.

As the cabinet secretary knows, the pilot scheme for rapid response vehicles that took place in Lanarkshire, which is in my region, is being evaluated externally. Does she agree that certain incidents that the Ambulance Service faces are best dealt with on a see-and-treat basis, and therefore RRVs can play a crucial role in providing an effective ambulance service in Scotland? Can she assure us that the proper regulations will be put in place to ensure that RRVs are used where appropriate and that traditional two-person vehicles are used where appropriate?

Christina McKelvie is right to say that the use of rapid response vehicles in Lanarkshire is currently subject to external evaluation, which is an important part of the overall process of building confidence in the system. I hope that all members agree that increasing the use of see and treat, as clinically appropriate, is the right thing to do. We all agree that we must reduce unnecessary admissions and journeys to hospital. See and treat is an important part of that.

Christina McKelvie's points about rapid response vehicles will be covered by the independent evaluation. On the one hand, we all agree that practices such as single manning of ambulances that should be double crewed are wrong and must be dealt with. On the other hand, I believe that the front-loaded model is right, but we must do more to build public confidence in it. That is an important distinction to make.

I join other members in welcoming the speed with which the cabinet secretary has responded to this undoubted glitch in the Ambulance Service, which is an otherwise excellent service. The cabinet secretary has responded by means of four different units: a panel under Ken Corsar, an inquiry by a senior clinician, the internal inquiry on the action plan and the chief medical officer's review. I am concerned about whether the public and staff will be able to respond to those four different inquiries. There is no sign of integration. We wanted a single integrated inquiry. How will she integrate the inquiries? Which inquiry will deal with using the global positioning system to report attendance within 200m of an incident? It is difficult to determine whether that relates to staff or data sharing. Will the cabinet secretary find a mechanism that will allow staff, who feel quite harassed, to speak freely to the various inquiries without fear of retribution?

Of course staff should speak freely. I make it clear to any member of the Scottish Ambulance Service staff that if they have something to say, they should feel free to say it. Many staff members have felt able to raise concerns with Opposition members and with me directly. That is one of the reasons why I made the statement.

I acknowledge Richard Simpson's point about the four different work streams, but I think that it is the right approach, because, as I said to Ross Finnie, although there are interrelationships and overlaps, we are talking about four distinct issues that require to be dealt with separately. All the issues will be taken forward in partnership. It is important to ensure that there is staff and trade union input. I will certainly ensure that the Parliament is kept informed of progress. It is right to say that, when we get further into the process, I will require to consider further how the different strands and conclusions of the inquiries are brought together. I will perhaps be able to update Parliament on that after the summer recess.

On GPS satellite navigation, which Cathy Jamieson raised previously, it is important to clarify that the eight-minute target has not been redefined in any way. We now have a system of automatic recording of ambulances arriving at the scene. We have had automatic recording of ambulances arriving at hospitals for some years. The recording system operates in addition to crews pressing a button manually when they arrive at the scene. The system is intended to record information more accurately and without the inevitable variation in practice that we get with a manual system. The recommended reasonable tolerance for the satellite navigation system is 200m, which, in time terms, equates to roughly 10 seconds. That is the tolerance that is applied to the target. Automatic recording is a more accurate way of recording the information, but if members have further concerns, I am more than happy to consider them. Given that we are talking about the data that are used to record category A performance, I expect the issue to feature in the investigation.

I repeat that there should be one question per member.

As the cabinet secretary will be aware, I represent a constituency that includes rural Kinross-shire, whose residents can be quite far from hospitals in time of emergency. Concerns have been expressed to me—as recently as lunch time today, by pupils of Kinross high school—about rumours and media reports of ambulances that are designed for two people running with just one paramedic on board, which, I assume, makes it hard, if not impossible, to deliver treatment on the move.

Question, please, Mr Brown.

Will the cabinet secretary clarify what has been happening with regard to the issue? Will the action that she is proposing to take reassure my constituents?

Keith Brown raises a valid and important point. I covered the issue in my statement, but I will again make it clear that single manning of accident and emergency units that should be double crewed should not be the general rule and should happen only in exceptional circumstances. Usually, there should be double crewing of the units, and one of the crew members should be a paramedic.

The issue is not new, and it is right that we step up action to address it. That is why the Scottish Ambulance Service will, by the end of the month, submit to me its action plan to eliminate rostered single manning.

Does the cabinet secretary have statistics on ambulances that were dispatched but subsequently stood down following a paramedic triage stand-down message to the central base? How do management ensure that the risk assessments have been clearly understood by the primary care staff involved? Are protocols that can be understood clearly by the public in place, so that their expectations can be managed and confidence in our Ambulance Service is not further damaged?

Of course protocols are in place to deal with the scenarios to which Helen Eadie refers. The dispatch centre will make decisions about the appropriate type of vehicle to dispatch to a call. Of course, the dispatch centre makes decisions about the categorisation of calls as well, and protocols underpin all of that decision making.

I do not have to hand statistics on the number of double-crewed ambulances that were dispatched and then stood down. If those statistics are gathered centrally—I imagine that they are, but I do not want to give a categorical assurance without checking—I will ensure that they are given to Helen Eadie in writing.

I would like to press the cabinet secretary a little further on the review that is being headed up by Ken Corsar. No organisation, let alone a major service organisation, can afford to operate for any length of time with its management effectively in limbo. Does she expect the review to be short? What brief has Pauline Moore been given in the interim? Does the cabinet secretary expect the meeting that was to take place on August 12 to take place before or after the various reviews that have been initiated?

The date for the annual review, which I have decided to move to early autumn to allow progress to be made, will be set before or around the time when I meet the Scottish Ambulance Service on 2 July to discuss the range of issues that will be covered in the annual review. I will ensure that members are notified of that as quickly as possible.

I emphasise that the investigation that is being headed up by Ken Corsar was established not by me but by the board of the Scottish Ambulance Service—that is an important point of principle. The investigation is into allegations of bullying and harassment, and it concerns employees of the Scottish Ambulance Service, therefore it is right and proper that it is dealt with by the board of the service, in its capacity as employer. It is, therefore, not appropriate for me to comment further on the review, except to say that steps have been taken to ensure operational continuity in the service while the chief executive and operating officer are on temporary leave.

Pauline Moore is the acting chief executive. She has a wealth of experience that will stand her in good stead for the task. Any management support that she needs will be provided by the Scottish Ambulance Service, with help from the Scottish Government health department, where appropriate.

On pages 7, 8 and 9 of the written version of her statement, the cabinet secretary frankly acknowledges the staffing problems that I have outlined. Can she assure me that, when she conducts an audit, as it were, of why we are where we are with regard to the unfortunate situation in north-west Sutherland, officials will at least correspond with health professionals in the area, particularly GPs, who will have useful knowledge to impart? As part of her efforts on managing recruitment, will she undertake to consider part-time work, as such employment does nothing to boost recruitment in areas such as north-west Sutherland?

I am happy to confirm that the work that I have requested from the Scottish Ambulance Service will cover the issues to which Jamie Stone refers. I am also happy to confirm that, in taking forward that work, all relevant interests will be considered. I am more than happy to hear from any stakeholder or person who can bring experience to bear. I mentioned that, a couple of weeks ago, I visited not Sutherland but Wester Ross, to discuss issues with the people who live there. I am more than happy to continue to engage in that way.

It is important that we accelerate the pace at which we deal with single manning. In the chamber a couple of weeks ago, I told Jamie Stone that I had asked for regular reports about that. I am determined to press ahead to eliminate that practice, which has no place in the Ambulance Service.

The cabinet secretary will be aware of concerns about how operational research consultancy—ORCON—targets are being applied, particularly for category A calls, which must be responded to within eight minutes. Does she acknowledge the perverse logic in how that target is applied? If the crew arrives in seven minutes and the casualty dies, that is classed as a success, whereas if the crew arrives in nine minutes and the casualty makes a full recovery, that is classed as a failure. Will she consider further how we can move towards a more outcome-based approach to assessing how the Ambulance Service responds?

I understand where Michael Matheson comes from in asking his questions. The eight-minute target was set not by this Government but by the previous Administration, which acted on the basis of international evidence. The target is right, but I am determined to ensure that the performance measures that lead to judgments about whether the target is being met are right, proper and robust. I challenge the notion that it is a failure if an ambulance crew turns up in nine minutes and the patient survives. Of course, that means that the eight-minute target has not been met, but that is only one aspect of performance. Nobody would consider that result to be a failure. We must consider issues in the round but, in the whole picture, the eight-minute target has an important place and is right for category A calls.

In the debate two weeks ago, concerns were expressed about the cleanliness of vehicles and the impact on health and safety of pressures on staff. The cabinet secretary's statement did not directly address those issues, so will she undertake to examine them as part of the investigation that she outlined and to report to Parliament in due course?

I am happy to do that and to report to Parliament when I make a fuller statement. Members will know the importance that I attach to cleanliness and infection control in the NHS, which applies to ambulances just as it does to hospitals. The importance of cleaning ambulances cannot be overstated. Ambulances must be cleaned rigorously, and I expect that to happen. Some ambulances are now being cleaned by hospital cleaning staff rather than ambulance crews, to free them to do other tasks, but the standard of cleaning cannot be compromised on. I would take seriously any suggestion that that was happening.

I am afraid that we must move to the next item of business. I apologise to the three members whom I could not call. As I have said, the next debate is extremely tightly subscribed.