Civil Contingencies Act 2004 (Amendment of List of Responders) Order 2008

I thank the Minister for introducing the order, which is straightforward in its purpose and content. In broad terms, I take no issue with it. However, a few questions arise. Two of the defining features of a foundation trust are the greater degree of autonomy that it enjoys, as compared with a non-foundation trust, and the fact that it is not performance-managed by a strategic health authority. Given that these features apply, I am not clear about what drivers will exist to ensure that the care of patients who have been looked after by an ambulance foundation trust and then passed across to the A&E department of an acute NHS trust will be seamless and of a uniformly high standard. I appreciate that foundation trusts have a duty of co-operation with the wider NHS, but that does not seem to be sufficient to guarantee that the interaction between an ambulance foundation trust and an acute trust will make the quality of the whole patient journey something that the ambulance trust makes one of its specific priorities. What matters to a foundation trust in terms of demonstrating that it has performed well is that it has met certain benchmarks relating to the care that it delivers. Whether or not it has facilitated good care delivered by another provider is not central to its mission. On the other hand, what matters to a badly injured patient is not just the length of initial response time by the ambulance, or whether he is well looked after en route to A&E, but how long it takes him to access high-dependency care in hospital. Not for a minute do I wish to sound critical of ambulance crews, whose professionalism and dedication are not in question. I am just a little concerned that the systems and structures that we are setting up may not always work to the maximum extent possible in favour of good patient care, and that the greater insularity of an ambulance foundation trust may, in practice, not be wholly conducive to the delivery of optimum patient care along the entire patient pathway. On a different issue, one of the other distinguishing features of foundation trusts is that they are fully subject to the tariff system. What progress is being made to apply a workable and credible tariff system to ambulance trusts, and how will this operate? Is it anticipated that there will be any change in target response times for ambulances, if and when ambulance trusts are overseen by Monitor? On a factual point, I should be glad to know how many ambulance trusts have indicated a wish to apply for foundation status. Reverting to the content of the order, what steps are being taken to ensure that disaster preparedness training is being extended to these trusts, so that staff remain fully briefed and prepared for the worst? Will these civil contingencies duties be built into the functions of ambulance foundation trusts?