COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY

OFFICIAL REPORT
(Hansard)

Alpha 5 Ireland Air Ambulance

24 January 2008

Members present for all or part of the proceedings:
Mrs Iris Robinson (Chairperson)
Mrs Michelle O’Neill (Deputy Chairperson)
Mr Thomas Buchanan
Rev Dr Robert Coulter
Dr Kieran Deeny
Mr Alex Easton
Mr Tommy Gallagher
Mrs Carmel Hanna
Mr John McCallister
Ms Carál Ní Chuilín
Ms Sue Ramsey

Witnesses:
Mr Jerry Carr ) Alpha 5 Ireland Air Ambulance
Mr Mark Sellers )

We now have an evidence session with representatives from Alpha 5 Ireland Air Ambulance. I welcome Jerry Carr and Mark Sellers. I remind Members that Alpha 5 asked for an opportunity to brief the Committee on its proposals for an air ambulance in Northern Ireland. I refer Members to extracts from the Alpha 5 website and some suggested issues that have been prepared in the papers. I invite Jerry and Mark to give their presentation, which should last approximately ten minutes. After that, I will open the floor to discussion and questions. You are both very welcome.

Mr Jerry Carr (Alpha 5 Ireland Air Ambulance):
Thank you for the opportunity to address the Committee this afternoon. I am the operations director for Alpha 5 Ireland Air Ambulance. I am married to a Belfast lady, so that is what brought me over here. I have been living here for 11 years, but the first time that I stepped foot on this side of Ireland was 21 years ago. I grew to love the place and decided to settle here, and I live in Bangor now.

A long time ago, my friend worked with London air ambulance and he asked me to help them with an internal matter. I come from a computing background, so I was able to assist. I was invited to meet the medical crew and the aviation crew, and I was overwhelmed by the good work that they did. I invited some of the London air ambulance staff here, and they could not understand why there was no air ambulance service in the North of Ireland. Four years ago, we put a plan together to determine whether such a service was feasible, whether it was needed and where it was needed. That culminated in a fundraising plan to try to secure the funds for an air ambulance service to cover the North of Ireland. Mark will provide information on how the service will operate and who will benefit from it.

Mr Mark Sellers (Alpha 5 Ireland Air Ambulance):
Thank you for the invitation to address the Committee. I do not actually live here — I am from London — but I got rather drunk at a wedding here, and a few businessmen asked me if I could bring an air ambulance to Northern Ireland, so I agreed. The following morning, I was not too sure whether I had done the right thing. However, we have been preparing to bring the service to Northern Ireland for three years now.

I am the aviation director, and Jerry looks after the corporate funding and public donations. I have been invited on board to set up the helicopter, to interview the medics, and so on.

When a 999 call is made, we will aim to be airborne within three minutes. We will cover a large area — it will not just be Northern Ireland. I can get to Dublin in 52 minutes, which beats the golden hour. That will not give the doctor much time, but there will be a large area to cover. We cover the largest area, compared to the Great North air ambulance and Cumbria air ambulance, which have three helicopters to cover the same area. Therefore, it will be expensive for us, because we will need a larger aircraft.

The Helicopter Emergency Medical Service (HEMS) operation that we propose to bring here will not be a scoop-and-run service with a couple of paramedics on board. Paramedics are fantastic at what they do, and I have nothing against them. However, if a lot of money is going to be spent, the service must have a doctor on board to be effective. Basically, we will bring A&E to the incident. It is unbelievable to witness such a service in action. The air ambulance service elsewhere does not get called out as many times as the normal Ambulance Service, but three or four jobs a day is enough for the team. Trauma doctors work with the service for a maximum of six months and then they are released because they become traumatised themselves.

As I said, when a 999 call is made, the air ambulance will be airborne within three minutes, and we will aim to reach most accidents within 30 minutes.

Mr Carr:
The focus of this operation is to provide an emergency air ambulance service, which is different to purely transferring patients from one hospital to another. As it will be an emergency air ambulance service, it will have a fully-qualified trauma doctor on board, as opposed to a general practitioner who could stabilise the patient and then take them to the hospital that is best suited to their needs.

Therefore, they may be taken to the Ulster Hospital for burns or to the Royal Hospital for neuroinjury; whichever is the best hospital for the patient. The service is not restricted by a directive that states that patients must be taken to the nearest A&E unit. Because of that, remote areas in the west or the far north of the island can be covered; whether there is a local A&E unit is irrelevant. An air ambulance that is dispatched from the base that we have in mind at Aldergrove can reach Omagh, for example, within 16 minutes. That is the time that it takes to get a trauma doctor to the location, stabilise the patient and bring him or her to the most suitable hospital.

The air ambulance service will work hand in hand with the land Ambulance Service. It will be a joint effort. Once the patient is stabilised, that does not necessarily mean that he or she is put on the aircraft and taken to hospital. The land ambulance may be able to take over. The most important consideration is whether the person is able to travel safely to a hospital that can deal with his or her treatment from then onwards.

The region that can be covered from the operational base at Aldergrove during the crucial “golden hour” extends to the furthest point of the North of Ireland, which can be reached within 30 minutes. If one assumes that the patient is then taken to the most suitable A&E hospital, the journey should be made well within an hour. The patient travels with a trauma doctor and a paramedic.

Mr Sellers:
The charity has estimated the amount of necessary funding. It cannot determine, pound for pound, what will actually be spent. Because such a large area is covered, bills for the aircraft are astronomical. The biggest cost is not for buying or leasing the aircraft; it is for the airtime that must be paid. If one approaches companies such as Bond Aviation or PDG Helicopters in Scotland, for example, they will provide the cost of simply leasing an aircraft with a couple of pilots. They will not, however, mention the running costs that they charge for airtime. Every hour in the air costs £500. A round trip can take two hours. That amounts to £500 plus £500, as well as the cost to lease the aircraft for the day, the price of fuel and hangarage fees on top.

Alpha 5 Air Ambulance is prepared to carry out transfers. That would not be a problem. It has the necessary crew and aircraft. However, costing that is a problem. The charity will supply finance of £55,000 to £60,000 each week in order to lease an aircraft with a full crew, including a winch operator, with insurance. However, there are added costs that are a big part of running an air ambulance service.

The charity is currently in deep negotiations with a particular company with regard to leasing an aircraft for three years. That gives the charity three years to save up enough money to purchase its own aircraft. It will cost £41,000 each month to purchase an aircraft though a lease deal that one might get for a car. It will take the charity around three — possibly five — years to get to that point. My understanding of Mr Carr’s figures is that it looks as though the charity is currently a year in front of itself. It set a target to be airborne by 2010; however, it looks as though it will be airborne a year earlier. The way that the charity is going at present, it will be in a position to place an order and to pay a £500,000 deposit to the leasing company by Christmas. There is not much time with which to work. It will take a year from the point at which I order the aircraft with the other aviators. We have a sorter with the leasing company.

The correct aircraft must be chosen. The conditions for aircraft in Northern Ireland are different to those in the rest of the UK. Believe it or not, the weather here is ferocious.

Our organization would have to pay a lot more in pilots’ wages than do organizations on the mainland because our pilots would have to be instrument rated (IR). Such a rating enables pilots to fly using only the instruments when they are unable to see anything through the plane window — that would allow them to fly through all the bad weather here. Most air-ambulance pilots on the mainland do not need that qualification as it is mostly visual-flight pilots who are required there. Thus, that extra requirement would mean extra costs for the service.

The helicopter engines would have to be cleaned every day because of the salt in the air here, which would be another additional cost. It is by adding those small additional costs to the other costs that we arrived at the figure of £2·5 million, which is how much we believe it would cost to run the service for a year, using one aircraft. The cost of a second aircraft would be cheaper, and we hope to eventually have five aircrafts around Ireland. It is a bit like buying two cars from someone instead of just the one.

Alpha 5’s aim is to reach the target of £2·5 million. It would like some money from the Health Service, if possible, or from other Government bodies. Jerry and I have tried to prove to the Health Service that this service can be run on public donations, without corporate funding. I worked with London’s Air Ambulance, which suffered massively by relying on Richard Branson and everyone else to provide funding from year to year. The man was fantastic to the service, and he still is, but if he pulled away from it, it would be in big trouble. That has happened with other air ambulance services as well.

When we came to Ireland, we decided to build the service back to front, and to get the people behind us to support it. I understand that Jerry has spoken to three big corporate companies and that they have all come on board now, which means extra money for Alpha 5 as the years go on. That is a bonus for the service, as it will eventually be able to purchase its own aircraft. However, we are not looking for corporate funding; we must work from the ground up with the public, and obviously, politicians.

Mr Carr:
I would like to correct my colleague slightly: we do not want the service to be financed purely by public donations — we have to have some input from businesses. The campaign involving the businesses commences the middle of next month. The three companies that I have contacted — as a tester, if you like, to see what their reaction would be before we commenced that campaign — have all jumped on board, which is obviously good news.

Our aim is to create a sustainable service; we do not want to fly a nice new shiny helicopter for six months, and then leave it to sit in a dusty shed for the next couple of years because we have run out of money. We were conscious of the need to ensure that the service could be sustainable, which is why we spoke to the public in the first instance. Consequently, a distribution team is organising people to get out and about across the region with collections boxes, and a number of members of the public have sent up standing orders to the service. The businesses will be involved in raising the capital needed to commence the service, while public money would be focused more on providing the sustainable funding that is needed to keep the service going.

Our aim is to mirror the situation in Wales, whereby the Welsh Assembly makes a contribution of around £100,000 a year to the service, which operates three air ambulances at the moment. That is the kind of assistance that we would hope to get.

Even though the service will cover the border counties in the South as well, it is the Northern Ireland Ambulance Service ambulance control that would call through the work — it would be up to its operators to decide whether the air ambulance service were given a job or not. We want the service to be made available to anybody who needs help, but it would be the Northern Ireland Ambulance Service who would determine whether or not it would be called out to an incident.

I thank the Committee for its time.

The Chairperson:
Thank you for the presentation. I will kick-start with a few very practical questions.

The website suggests that Alpha 5 is a registered charity. Does it have a board of trustees? Are audited accounts maintained, and who audits them? Are the accounts open to scrutiny, and are returns made to the Inland Revenue?

Mr Carr:
Yes, Alpha 5 is registered as a charity in Northern Ireland with HM Revenue and Customs and the Inland Revenue.

We have not been going long enough to have a set of accounts done yet, but that will be done in March by chartered accountants Harbinson Mulholland who are based in IBM House in Belfast. We have trustees on board now, and we are still recruiting trustees. For example, one of the people who are coming on board as a trustee is a senior member with Tesco.

Does that answer all the questions?

The Chairperson:
Yes, thank you. You have pressed all the buttons, but there is just one more thing. Have you had any initial meetings with the Minister of Health Social Services and Public Safety, or even the Ambulance Service, and if so, what sort of response have you had?

Mr Carr:
Yes, to the first two questions. We met with the Health Minister’s team midway through 2007 after an invitation from the Health Minister’s office. The meeting was an update to get him up to speed on who we are, why we are doing this, and to advise him of our intentions, which we have carried on doing.

Before that, in about April, we had a meeting with the Northern Ireland Ambulance Service.

Mr Sellars:
I have had three meetings with the Northern Ireland Ambulance Service, which was my first port of call, and they then started to guide us into the areas where we should be going.

Mr Buchanan:
This appears to be a good concept, especially for those in rural areas, where there is poor road infrastructure and a lack of emergency service cover, etc. However, it seems to cost a phenomenal amount. You have talked about donations from businesses for capital funding and to set it up along with fundraising by the public. Are you confident that, year on year, the funding will come in from all of those bodies in order to keep the service up and running if you can achieve that?

As you are based in Northern Ireland, how will all of that be administered? Have you employed people, are they paid from charitable donations and how much will the whole set-up cost? It is a good, exciting concept, but we need to be clear that you are confident that all the costs can be met from the sources that you have told us about.

Mr Carr:
The simple answer is yes. We have done our sums, and poured over this for quite some time with greater financial minds than ours. We currently have seven staff employed, and we also have somewhere around 70 to 80 volunteers right across the region, who come from Omagh, Portaferry, Coleraine, Ballymena and Dungannon. I also had a call this morning from people in Cookstown who want to become involved. All those people work with us on a daily basis on fundraising. We were conscious right from the beginning that this needed to be a sustainable service.

Securing the initial funding to get the service up and running is not seen as the biggest problem or headache. We have to put the financial plans in place to allow the service to run year in and year out. That is why we have focused on the standing orders and direct debits that people out on the street are signing every day, and that is the basis of the service. We work very hard on that, and we also know from our distribution team that the collection boxes reflect that.

We have spoken to senior people in organisations such as the Royal National Lifeboat Institution, and they have given us good advice on the types of returns that one could expect from those types of scenarios. One must work hard to get products such as tin boxes out there, but they are a great deal of help in sustaining the service.

Mr Sellers:
Around £1 million a year is raised through our 22,500 collection tins, and we spent £150,000 on putting that into production. The charity raises £2·5 million a year, and we rely on the aircraft every day. A hospital, for instance, may need a machine in December that could not be supplied until March. However, the Air Ambulance is not that type of charity. We incur costs, probably more than other charities do, because we have to employ full-time professionals to ensure that the aircraft is kept running. We cannot rely on good faith and volunteers. Therefore, we have had to spend a lot of money on the recruitment of agents in every county, and we hope to recruit another 14 agents by Christmas 2008. Those agents will look after our collection tins, bringing in between £1 million and £1·25 million a year. However, it costs £250,000 to run that recruitment process, so we are in a catch-22 situation. We would like to keep that £250,000, but it not possible to do that. Our fund-raising teams operate seven days a week and we also have to pay them. We need money every single day. It is nice when volunteers turn up for a couple of hours, and it helps, but a couple of hours of help is not good enough for us.

Mr Carr:
The question on the funding that is required to maintain the service is a fair one. The Great North Air Ambulance, for example, went offline for six weeks because it ran out of money. Many years ago, London’s Air Ambulance was close to shutting down as it faced some issues. However, we have learned from our naivety. The service was run by professionals from the medical world or the aviation world, not by professionals in fundraising. Therefore, funding problems ensued. London’s Air Ambulance was lucky in that Sir Richard Branson stepped in to help it out. The Yorkshire Air Ambulance had a problem, and Richard Hammond is helping it out.

Mr Sellers:
The professional charities that employ internally, such as the Cornwall Air Ambulance, are very wealthy because they have invested money into their charity. As Jerry rightly said, doctors, surgeons, chief pilots and delta alpha pilots are not fundraisers. Those guys are good at what they do, but they cannot be expected to run a charity. The charity aspect must be divided from the working aspects of the service. Alpha 5 will be the operator for the charity, but it is a sister company and it is a non-profit-making company. The fundraisers work from the charity, and although we accumulate a cost, that is unavoidable.

Mr Easton:
Have you carried out any research in the form of a feasibility study on the need for an air ambulance for Northern Ireland? Have you identified a site for where the service would be based, and have you agreed where that would be? Who will decide on the case for the need for an ambulance or air ambulance?

Mr Sellers:
The deployment of the service would be the responsibility of Northern Ireland Ambulance Service, which is based at Knockbracken. Every morning, we would speak to a clinical director or someone else that is involved with the Ambulance Service. We would tell that person, who is appointed by the Ambulance Service, when we are online. That would usually be at 8.00 am. It is down to the Ambulance Service where it deploys us, as it is the deployment centre. We can tell it that we are fully fuelled and how far we can get in a certain amount of time.

Working alongside us, the Fire and Police Services become familiar with the trends of Ambulance Service deployment. For example, if a fire engine is the first emergency-services vehicle to arrive at the scene of a fire, and the chief fire officer is familiar with our work and has used us before, he would know to call us out if someone had fallen more than 10 feet from a top window but not to call us simply to treat a lady suffering from an asthma attack. The chief fire officer would know that that is a job for HEMS, and it would be his decision to call us, although such a request would usually be submitted via the Ambulance Service. Over time, all the emergency services would learn how to deal with such an incident and when to call us. However, from the word go, we should be deployed by the Northern Ireland Ambulance Service.

Turning to your second question, we considered three sites — Enniskillen (St Angelo) Airport, Belfast City Airport and Belfast International Airport. On the map, Belfast International Airport is centrally located for aviation. Enniskillen (St Angelo) Airport is too far from the east coast, and basing our services there would add 17 minutes to such a journey, which is time that could not be lost. Belfast City Airport has the same problem; we would lose approximately nine minutes getting to the west coast.

Although Belfast International Airport is not exactly in the middle of the country, it would give us a better chance of getting to an incident quickly. In addition, it has all the facilities that would be required for our aircraft: hangarage, new hangars are being built; an area in which our maintenance team could work on the aircraft every night, which is obligatory for an emergency aircraft; and fuelling — believe it or not, some airfields do not hold the Jet A-1 fuel that twin-turbine aircraft use.

If we were to bring a second aircraft into use, we might consider moving both aircraft to different parts of the country. However, for the first aircraft, Belfast International Airport would be our choice because it would allow us to fly north, south, east or west in under 30 minutes.

Mr Carr:
Every two weeks, people telephone or email us offering sites at which to base our aircraft. However, Mark Sellers is considering the sites that offer the most comprehensive coverage.

Mr Sellers:
We have also heard rumours that a helipad is to be built at the Royal Victoria Hospital, and we have been asked whether we would base ourselves there. It would be fantastic if a helipad could be built at the Royal, but we could not base our aircraft there for the same reason that ruled out Belfast City Airport. We are drawn back to Belfast International Airport, which is well situated for reaching the north of the country.

Mrs O’Neill:
I agree with the concept of an air ambulance, and I have even asked the Minister about such a thing. However, if you were to reach your financial targets tomorrow, and were able to have an aircraft, is it true that you do not have an agreement with the Department for the use of your services?

Mr Sellers:
That is right. Currently, we do not have any stakeholders.

Mrs O’Neill:
Is that not a roundabout way to do things? Should you not have presented a business case and established an agreement with the Department? Obviously, before using your services, the Department would have to justify the need for an air ambulance.

Mr Sellers:
That is right. However, when we approached the Ambulance Service — way before 8 May 2007 — people did not know what was going on.

People like, the Minister with responsibility for health and Bairbre de Brún , did not know what was going on.

We approached the Northern Ireland Ambulance Service and spoke to Dr David McManus. We chatted, and all agreed that it was a good service. However, there was little point in approaching Stormont at that time. It was six months before 8 May 2007, when ministerial roles would, perhaps, change. The word I gave to David McManus was as follows: we would go away, and set up the charity; once the charity had some stabilisation, we would sit down with the Minister and the Department to discuss the situation.

That is exactly what we have done; that is why we are sitting here today. We could have come here three months ago, but we were not prepared for it. We wanted to settle the charity and to see how it was running; now, we know that it is moving in the right direction. The aviation companies are sitting at the side, waiting for us to come on board.

Until this point, the charity was not ready. Three or four months ago, there was no point in our coming here and making promises that we could not keep. Now, however, we are planning to bring an aircraft on board this Christmas. If the Department decides that it does not want the service, then Ireland is left with an aircraft sitting on the tarmac, for it to use at any time. However, over 70,000 people are behind us, and £15,000 per month comes in. We have given the public our word. Perhaps we have done that innocently. There was no point in approaching health parties for serious discussions until we felt that charity had stabilised.

Mr Carr ( Alpha 5 Ireland Air Ambulance):
We are answering two questions at once. A member has asked us whether we had conducted feasibility studies, or anything on those lines, to ascertain whether an air ambulance is needed here. “Feasibility study” is not an appropriate description. We have not commissioned a 300-page report or anything like that. However, it is very difficult to find people who believe that an air ambulance service would not be of benefit. We have spoken with many ensconced in the Health Service and emergency services and also with many members of the public. Every man, woman and child wants an air ambulance service up-and-running yesterday. That is what has spurred us to carry on with this plan.

The Chairperson:
Your question has been answered, Mr Easton.

Rev Dr Robert Coulter:
I am interested in your costings. You have to wash down the engine every second night because the salt content of the air in Northern Ireland is worse than anywhere else. Tell us more.

Mr Sellers:

It is not worse than anywhere else. However, I spoke to the police support unit at Aldergrove and asked Andy, the chief pilot — who has since left — what particular problems he faced there. He replied that he had encountered massive problems with the engines on the EC 135. He said that if we go for a Dauphin N3 or a Dauphin 155, we will also face the problem of salt in the air. He said that the engines must be cleaned every day: it is only half an hour’s work, but it cost money.

Rev Dr Robert Coulter:
I have owned and flown aircraft here for many years. That is the first time I have heard of this.

Mr Sellers:
That is what we have been told a former chief pilot at the police support unit at Aldergrove. Furthermore, one of our trustees, who has acquired 3,300 hours of flight time, also flies in Ireland. He has also encountered this problem, on a Gazelle.

Rev Dr Robert Coulter:
I cannot believe it.

You have said nothing about the paramedics going with you. Do you envisage the paramedic going to Aldergrove to join the aircraft, or will the paramedic be at the scene of the accident and return with you and the patient? If so, how does the paramedic get back to his base?

Mr Sellers:
Paramedic and doctor should both be seconded to us at Aldergrove. They spend their time according to whatever rotas the Health Service gives them. However, they have to be seconded to us; they cannot be on bleepers; we cannot fly to a hospital to pick them up. They need to be trained in the helicopter emergency medical service (HEMS). The doctor, obviously, must be an anaesthetist, and he will have to train the paramedic on the drugs situation.

Meeting a paramedic at the scene, and expecting the paramedic to assist in the particular way that doctor wants to work, is not out of the question; it happens. Paramedics all help out. However, it would be better for the doctor to have his or her paramedic beside him at all times. They build up a bond and work together.

About the paramedic getting back and forth to work, that is part and parcel of the job and he will have to travel to Aldergrove for his day’s work.

Mr Carr:
Both will stay at base, ready to go, as happens in other air ambulance services that operate across England and Wales. The service will be scrambled by an emergency code word and tasking will come in from ambulance control. They have to be ready to go, up and away, within three minutes. We intend to mirror other air-ambulance services.

Rev Dr Robert Coulter:
Do I understand you correctly? Did you say that the pilots would be from England?

Mr Sellers:
No. We have already sourced the pilots. They are all here.

Mr Gallagher:
I thank the witnesses for their submission.

I, like other speakers from the west, recognise the importance of having an air ambulance available. We are getting to that point. In the paper you have presented, you mention the border counties: Cavan, Monaghan, Louth, Meath, Sligo and so on. With that in mind, you may know that the previous Assembly initiated a feasibility study. The two Governments agreed to carry it out; it was completed and published. Whatever arrangements exist between the two Governments, it is important that there is agreement. I cannot see that it will work without that capacity.

What are your views on that feasibility study? Have you looked at it?

Mr Carr:
That is the ‘Feasibility Study On A Helicopter Emergency Medical Service (Hems) For The Island Of Ireland’ by Booz Allen Hamilton.

Mr Gallagher:
I do not know the name of it, but it was a joint Government report that identified three locations. Your submission described your discussions with the Northern Ireland Ambulance Service. Have you had discussions with the emergency services in the other jurisdiction?

Mr Sellers:
We have not. The reason for that is that a charity has just been formed in the Republic, on the west coast — south-east or south-west, I cannot remember where it is now. We do not want to infringe on their fund-raising efforts. Two charities can get quite bitchy. It is very territorial. We have been keeping a close eye on the reports in the media. Apparently, that charity has approached the Health Service in the Republic, and they have met the same sort of reaction that we have done here.

As we have stated in our information, we are non-political; we are a charity; and at the end of the day, all we are interested in is saving people’s lives. Gerry agrees with me: our charity will not get into any discussions about politics. It will be a free service for the people of Ireland. If Dublin calls us and there has been a serious incident down there, and we have enough fuel and enough medics, we will go. If we are asked to go, we will go.

There are no borders between charities and air ambulances — there never has been, and there never will be. We do not want to get into that type of discussion. All that we are saying to the Health Service is that we have the aircraft, the fuel, the pilots and the medics; we can be deployed wherever the Health Service wishes.

If somebody rings us from Cavan, for example, who has fallen off a ladder, we cannot take that call because we have not been deployed by the Ambulance Service — it is down to the Ambulance Service and the emergency services to deploy us. I do not think that it would take much effort for the two emergency service sectors, North and South, to meet around a table and discuss this. If we are present, we can insist that it will not take long to sort this out.

Mrs Hanna:
Several of us have talked about the need for an air ambulance in the past, particularly for the rural areas. The entire charity status issue is something that is new to us, especially in the area of health. You talked about sustainability, but is it not true that there is much uncertainty regarding charity status? You talked about Sir Richard Branson coming in and rescuing a service — I cannot help but wonder how sustainable these services are.

You said that the doctors would be trained in the area of accident and emergency — would they be seconded from the Health Service, on six-monthly periods, for example? I also seek information on the relationship between the air ambulance services and the Department of Health. As someone who is a very strong supporter of the National Health Service, I am not sure about the charity status, or the private status, and I would be interested in obtaining more information about those relationships. I would have some concerns if something was totally private.

I think that the Health Service should have a presence in the make-up of an air ambulance service; for sustainability, as well as the fact that they are going to be part of the National Health Service. The insurance must be a very big expense in a service like this.

Mr Carr:
On the charitable status, going back to the example of Sir Richard Branson, the London Air Ambulances charity was in its infancy when Sir Richard Branson stepped in. It is much stronger now. The problem that is faced by such a service if it goes down a purely corporate route is that, in three years’ time, for example, Formula One racing could be more fashionable than football. Then, in six years’ time, rugby could become more fashionable that Formula One racing. The services tend to go wherever makes sense for backing — that is understandable. This is why, as we have said, we have focused on sustainability.

Similarly, we were at the Duxford Air Show in October 2007, and there was a number of air ambulances there. I remember taking a photograph of one; it was the Lincolnshire and Nottinghamshire air ambulance. Proudly stated on the side of the aircraft was a statement that the aircraft was funded by and provided for the people of Nottinghamshire and Lincolnshire. Any companies that want to get involved have got to realise that; they might be getting some mileage out of it, but it is not for them — it is for the people that they are serving. It is as simple as that — that is what the air ambulance scenario is all about.

Regarding the doctors or the medical staff that are seconded to these services — as has been stated to us by the people in London — the Health Service there are delighted to assign their doctors and paramedics to the aircraft, because they say that the medical staff will never get training like it anywhere else. They reckon that six months on an air ambulance is worth five years in an accident and emergency department. Upon returning to an accident and emergency department after their period with an air ambulance service, that doctor or paramedic will basically have had five years’ worth of training in six months; because virtually every call is serious, and critical. That relationship is fairly easy to operate because everybody is happy and comfortable with that.

Dr Deeny:
You are more that welcome, Jerry and Mark. It is nice to see you both; I have talked to both of you before. I think that both the Health Committee and I as a doctor would love to ensure that we have as good a health service for the patients here in Northern Ireland as we possibly can.

I support the concept of an air ambulance, because it is part of the future of modern emergency healthcare. You talked about the services in Wales, Scotland and London. I saw how that service works on a recent visit to Scotland, and I was very impressed. Many medical professionals believe that it is the way forward.

A very sad incident involving a young girl occurred recently in Tommy Gallagher’s part of the country. I am not saying that an air ambulance would have saved that young girl’s life, but she was admitted to the local hospital with severe burns, and was transferred to Belfast, where there was no bed available, and had to be moved on to Dublin. It might not have made any difference, but I wonder whether that young girl could have been saved had she been lifted directly by an air ambulance.

Mr Sellers, you talked about instrument-led aircraft and the weather. Are you saying that those aircraft can operate in all weathers, including snow? Can you land anywhere? I take on board what Tommy Gallagher has said. I have worked for more than 20 years in the west. The roads are appalling, and we rely on ambulances all the time. The roads are full of potholes, and when the snow falls, some ambulance journeys can take up to two hours to get patients to an accident and emergency department. It is about saving lives.

I am interested in what is happening in Wales. The population of Wales is not much greater than our own.

Mr McCallister:
It is about 3,500,000 or 4,000,000 — about twice our population.

Dr Deeny:
Wales has three air ambulances. The members are concerned about the charitable status of the service. How long have those services been in operation in Wales? You said that those three air ambulances received an extra £100,000 a year from the Welsh Assembly. Has that service been supported and sustained by a charity?

How do you get your public support? Most of the people where I live would have heard of those services, and have seen them on television. Helicopters are used for different reasons in London, particularly because of the traffic, but many countries now use them as a way of saving people’s lives.

I hope that you can remember all my questions.

Mr Sellers:
I have written them down. I will begin with your question about the weather. When snow falls, the decision lies with the Civil Aviation Authority (CAA), Gatwick Airport and the chief pilot. It is their call. When bad weather occurs here, instrument-rated (IR) pilots can pull a screen down over the front of the aircraft so they do not have to look out of the window. The weather conditions over here come in so quickly, as Reverend Coulter will know. If you are “flying on visual”, you have a problem, because you have to fly around the weather systems and land if the weather is bad. We need more money for IR pilots; there are not many of them about. Only one in ten pilots of twin-turbine helicopters are instrument-rated, so they want more money.

If the wind is too high we would not take off, because that would contravene CAA regulations. Ice is also a problem. If we land in the middle of a field and are stuck there for two hours because the surgeon is working away, there is a chance that the engines will freeze up. The cost of de-icing the aircraft is £3,000. We are not going anywhere in that situation; we call it a ground assist. The surgeon will ground assist in the road ambulance back to the hospital, having stabilised the patient. At the very least, we will have delivered the surgeon. That happens rarely. We have had to leave a helicopter overnight on top of the helipad at the Royal London Hospital on a couple of occasions. We had to tie it down to prevent it being blown off the helipad.

We have to take that into consideration. The weather systems here are a little different to those in most parts of the mainland.

With regard to landing, I do not want to bore the Committee too much, but we fly under a licence called JAR OPS 3. That gives us entitlement from the Civil Aviation Authority (CAA) and the Irish Aviation Authority (IAA), basically, to fly and land where we wish. People get confused about where we can land. We could land outside CastleCourt shopping centre, if the pilot felt that it would be appropriate and safe to do so, and if the emergency services had cleared the road. We have been known to land in places where we have had to keep the rotor blades moving. We could not shut the rotor blades down, because they would have dropped and taken the tops off the cars that we landed next to. For example, we have landed in Oxford Street; the Committee might have seen photographs of us at work.

Landing is a matter of health and safety concern as well. The crew and the chief pilot are very responsible, and we have protocols that must be followed. There are no doctors running around in orange suits; it is not the way it is portrayed in films. Unfortunately, sometimes, we have to land a quarter of a mile away from the emergency. That is why we want to bring a winch-operating system into the aircraft. It is being tested at the moment by an air ambulance on the mainland. Everybody said that that would never happen, but it is happening. That would allow us to lower a surgeon at the scene of the emergency, rather than having to land a quarter of a mile away and the doctors having to run with Thomas life-support packs on their backs and arriving eight minutes late. That requires more money and investment.

We fly under JAR OPS 3, which means that we have right of way in the sky. Air traffic controllers are very good to us; they do what we call “stacking and racking”. If we were to fly through very busy airspace over Belfast, the air traffic control would stack and rack the aircraft so that we could cut right across their flight paths, rather than being diverted. We take priority over the ‘ India 99s’ — the call sign used by the police service — and the Army and royalty.

We work with air traffic control. If it puts a red light on for any reason, which very rarely happens, we must stop. Air traffic control is our eyes and ears. I do not think that anyone has a JAR OPS 3 licence in Northern Ireland at present, although I might be wrong.

If we were to fly across the border into the South, we would fly into the zone covered by the Irish Aviation Authority. Usually, we would need twelve-hour clearance in order to do that. If we were just to visit one of the hospitals there, for example, to say, “Hello” to the children, we would require permission from the IAA, and we would have to give 12-hours notice. The IAA has been in touch with us, and it has asked us to apply early for our JAR OPS 3 licence. That would give us a waiver, so that we could go into Irish airspace in an emergency without clearance. Nine out of 10 JAR OPS 3 licences are held by air ambulances. Few other aviation companies hold them.

I cannot tell the Committee how long the Wales Air Ambulance has existed as a charity. Like us, it started as a charity, but I cannot tell you how long it has been up and running, Dr Deeny. It has done very well to have three aircraft for a population of 3·3 million people. However, it is backed by the authorities.

Air ambulances are not backed only by health authorities. In London, Ken Livingstone backs the London’s Air Ambulance by giving them the occasional gift of £200,000, and so on. Local authorities make donations and everybody in the community gets involved. It is one of those services that receive good donations when they are up and running.

The Wales Air Ambulance has worked very hard, as they all do. Last week, I looked at the figures for the Kent service, which received much more than £3 million last year, and it has just brought a second aircraft into operation. That service is not funded by Government at all, according to its website, so it is doing very well.

There are many ways to ask for money from the public, and one is to organise a lottery, which every air ambulance has. We register for our gaming licence, and then put our own lottery in place. The problem that we found in Northern Ireland is that the Christian community tend not to play the lottery, which made us really downhearted, because we were hoping that the whole of Ireland would play the lottery, despite it having few prizes, because it is for a good cause. Although we have looked at the lottery option closely we are not sure whether we will go down that road or not.

Fifteen thousand girl guides have just been out with our standing orders, which are very important to us, and they have a lifespan of between four and seven years, according to other charities.

People look at one of our collection tins on a counter and estimate that it holds about £10. When there are 22,500 of them out there, the average for each tin is actually around £5·50 a month. That is quite a lot of money. However, it costs quite a lot of money to distribute those, but we hope to get the charity tins out there by Christmas and see a return from then on.

Mr Carr:
When we look at scenarios in England — the closest place to us that runs a number of our ambulances — we see regions such as Essex, Kent, Surrey, Sussex, Yorkshire, the north-west of England, the Great North that covers the north-east of England; and small places, such as Bedfordshire and Northamptonshire; that all have their own air ambulances. Hertfordshire is trying to bring one online at the moment. Every single one was founded and sustained in the way that we have described, and hard work has to be done year in and year out to make sure that the money keeps coming.

When Mark and I first became involved in this project we were looking for one new air ambulance to cover Northern Ireland. However, we now believe that it will take two to cover it comprehensively and make it available to the Northern Ireland Ambulance Service so that it can incorporate the service into the systems that it is running now.

Once the service is up and running and has flown its first mission it probably will not look back. Six months after that everyone at this table will be wondering how Northern Ireland did without it for so long. We are in the twenty-first century now; the Olympics are just around the corner; and I do not think that we can approach those days without a modern Health Service that incorporates an air ambulance service. That needs to be done sooner rather than later.

Dr Deeny:
You said the service starts at 8.00 am, but should there not be 24-hour cover? I witnessed the day of the awful Omagh bomb, and military air ambulances flew the injured to various hospitals, which saved dozens of lives that day.

Could a consultant in an outlying hospital, who has a patient needing urgent neurosurgery have him flown to the Royal hospital if he could not do the usual two-hour trip by road? Would you be able to pick that patient up in an inter-hospital transfer?

Mr Sellers:
Most certainly.

Dr Deeny:
So the service is a 24-hour one?

Mr Sellers:
No. Category ones, which are Helicopter Emergency Medical Service (HEMS) responses with a trauma doctor on board, fly during daylight hours, because they are not allowed to land on roadsides at night. It is hard enough to see pylons and cables in the daytime when looking down from above, because their lines cannot be seen. There are not many crews that would be prepared to land on the roadside even if it were allowed.

However, we are allowed to fly at night and do inter-hospital transfers as long as they have a designated landing site that is lit. The site does not have to be concrete; it does not have to be a £5 million all-singing, all-dancing helipad with “come and land on me” written on it. It simply needs to have some lighting and somewhere safe for the medics to approach the aircraft, and it needs to be cleared by the CAA, which is usually pretty good in that regard. Our chief pilots know what they are talking about regarding the advice that they can give to any hospital.

In other words, a £5 million helipad at a hospital is not required. For example, we could land in the park across the road from the Royal Victoria Hospital and we could land on the road during the day. If that park was lit, and a proposal was made to the CAA after health and safety checks, I do not think that there would be a problem. It is probably registered anyway.

The Chairperson:
All members who indicated that they wanted to ask questions have had the opportunity to do so. I thank Jerry and Mark for attending today and giving us such an interesting presentation. The Committee will discuss how the issue can be progressed.