§ 9. Mr. Simpson
To ask the Secretary of State for Health what national guidelines exist for hospital accident and emergency units on the standard tests to be undertaken in relation to young women in severe abdominal pain when brought to a hospital; and if he will make a statement. 
§ Mr. Malone
The management of any particular patient is a matter for the judgment of the clinicians involved. There are no national guidelines for such cases, but many hospitals have local protocols based on best clinical practice and taking account of local circumstances. I expect clinical judgment to be informed by the regular reports issued by the confidential inquiry into maternal deaths.
§ Mr. Simpson
I ask this question having just come through the traumatic experience of going to the local hospital with a family member who was left requiring almost emergency surgery, following the failure to carry out basic tests in the accident and emergency unit. Is the Minister aware that in the discussions that followed the clinical staff of the hospital said that the Government's failure to provide guidelines about basic tests which could and should be provided had left a huge loophole in the quality of emergency services on offer in hospitals around the country? Poor financial structuring renders reliance on professional judgment open to the fact that there are not enough professionally qualified staff in A and E units to ensure that people are not left unnecessarily in life-threatening circumstances.
§ Mr. Malone
I do not accept that from the hon. Gentleman. I know of his experience in the matter. That is why I have looked particularly carefully into what advice is given to those who exercise clinical judgment. It is for everyone who exercises clinical judgment in any situation in a hospital, be it in an accident and emergency unit or otherwise, to make him or herself aware of the advice. That is why we have the confidential inquiry which reports every three years into maternal deaths. It specifically recommends that when any young woman 758 presents problems of this kind, all steps should be taken to diagnose whether a pregnancy or ectopic pregnancy is involved.
The confidential inquiry is set to report again in the coming months and I understand that it will take that guidance further. I hope that that might give the hon. Gentleman some reassurance.
§ Sir Sydney Chapman
It is the opinion of the Royal College of Surgeons that one in four deaths in accident and emergency departments is avoidable. Does my hon. Friend agree that the most effective way in which the Government could respond to that appalling statistic is, at least in large urban areas, to recognise the advances that have been made in medical technology and concentrate more A and E resources in fewer hospitals? That would provide greater consultant and doctor cover. Could not the disadvantage to some of having to travel further be met by putting paramedics on every blue light ambulance?
§ Mr. Malone
I am sure my that hon. Friend will welcome the fact that, especially in the London ambulance service, increased use is being made of paramedics both in ambulances and on motor cycles. I take his point that we must provide the best possible accident and emergency service for everyone. It is for clinicians to guide how that can best be offered in the circumstances. I am sure that my hon. Friend welcomes the great increase in the number of accident and emergency specialist consultants.