Westminster Hall Sitting of 24 April 2001

Preamble
[SIR ALAN HASELHURST in the Chair]

Hampshire Ambulance Service
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Mike Hall.]
9.30 am
Sandra Gidley: I am grateful for the opportunity to discuss issues surrounding Hampshire ambulance service. Although some of the examples that I shall cite give grave cause for concern, I have the greatest respect and admiration for those at the sharp end, who deliver the service every day under difficult conditions.
My interest in the local ambulance service was awakened not long after my election, when I was contacted by the clerk of Lockerley parish council. She described the tragic case of an elderly gentleman who had suffered a heart attack at home; an ambulance had been called. Hampshire's is a rural ambulance service, and the target then was that an ambulance should arrive within 19 minutes for 95 per cent. of calls. In this instance, the ambulance took over half an hour to arrive. It had been sent from Hythe, which is not local, as there was no nearer one available. The driver later admitted that he did not know where Lockerley was, and that he had come via Dunbridge because it was a village that he knew. He also said that, had someone not been waiting on the main road running through Lockerley Green to direct him to the property, he would not have been able to find it. There is no happy ending to this story. The patient died. We shall never know whether the early arrival of an ambulance would have made the crucial difference, but the situation of the delayed ambulance was stressful for everyone concerned.
Having spoken out on this issue, I was contacted by a number of concerned ambulance men. One letter said that it was
"far from unexpected, and not a rare occurrence. The problem stems from a shortage of vehicles, and how that shortage is used.
In 1990, ORH (Operational Research into the Health Service) carried out a survey of Hampshire Ambulance Service—the workload, available vehicles, their location in relation to the workload—and made recommendations as to how the vehicles should be deployed. This involved an element of re-deployment—which was accepted both by the management and staff-side (prior to the publication of the report)—and the main statement that stands out is that the level of vehicle cover, and its deployment would provide the minimum cover required to achieve the necessary response standards. Actual ambulance figures are available, but ranged from a total of 23 at night-time to a maximum of 47 between 11.00 and 17.00 during the week, with reductions at weekends, resulting in a…daily…average of 30.87.
Since that time there has been a progressive reduction in vehicle availability, with a drastic increase in workload".
The figures bear out the increased work load. In 1995–96, there were 62,800 emergency calls. That figure had risen to 85,500 by 1999–2000—a 35 per cent.
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increase in four years. I am told that the work load has increased by 50 per cent. in six years, but I have not checked the figures.
Vehicle availability is down to 20 at night. That is an average of one ambulance per 75,000 population. The maximum varies daily from 41 to 43 between 3 pm and 5 pm and the overall average has dropped to 30.45. That might not sound like a huge drop, but set against the background of increasing work load, it shows a highly stretched service. These figures are for the whole of Hampshire and in each case the number is the maximum rostered. The figure is frequently not achieved because of sickness, holidays and training.
Many people are concerned about the fact that, at night, Southampton city has only two vehicles to cover a population of 220,000. There are ambulance stations at Bursledon, Eastleigh and Totton, but they have their own catchment areas to serve.
It would seem that, in addition to the problem in rural areas, towns and cities are not receiving a five-star service. I witnessed an example of that when I was out with the police in Eastleigh and an ambulance had to be called. It came from Whitchurch. There are six or seven ambulance stations closer to Eastleigh than Whitchurch.
In June the national response times were published. They made grim reading, and not only in Hampshire. Hampshire is regarded as a rural trust and has rural targets. That means that 50 per cent. Of calls should be responded to within eight minutes and 95 per cent. Within 19 minutes. I want to make it clear that those targets are for the whole of Hampshire. Many people think that shorter target times apply for built-up areas such as Southampton or Portsmouth, but I am afraid that that is not so. Anywhere in Hampshire is regarded as rural. Targets are exactly the same for the towns as for the villages.
Hampshire ambulance authority previously had a good record of achieving targets, but in the past year the percentage of responses made within eight minutes dropped to 44.5 per cent. and that for responses within 19 minutes dropped to 92.6 per cent. Both figures are well below the targets. However, to be fair to Hampshire, the performance of a majority of ambulance trusts declined sharply. The results are very worrying. I learned of other relevant incidents in the Lockerley area. On 11 May, an ambulance called at 2.30 am took one hour to arrive. On 18 May, an ambulance took 45 minutes to arrive. The crew admitted to getting lost.
I have met the chief executive and chief ambulance officer of Hampshire Ambulance, who have been frank and open. Various problems are apparent, but the basic one is underfunding. I have a letter from Richard Mawson, the chief ambulance officer, in which he refers to the funding discussions with health authorities with respect to 1999–2000. He states:
"Despite having faced an increase in demand of over 36 per cent. over the previous 5 years the service has managed to exceed the performance outcome year on year without significant additional funding. However, it was recognised, prior to 1999/2000 that the service faced a 'step change' which required additional funding if an unacceptable further erosion of workplace conditions for staff was to be avoided, whilst attempting to maintain standards. Unfortunately…we were unable to secure adequate additional funding to meet our identified needs."

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That suggests that there is a problem with the morale of ambulance men and women. Since taking an interest in the subject, I have spoken to many of them, and some common themes emerge from the concerns that they express. I have been universally impressed by those people, who do a difficult job under extreme pressure. They do not like the feeling that, for various reasons, they have not been able to give of their best.
The work load is hectic, which means that meal breaks are constantly interrupted, if they happen at all. The staff do not mind, but the system is now so tightly run that it is an everyday occurrence. No one appears to have undertaken a risk assessment to show the effects on performance of long hours without food. None of the staff members minds working extra hours, but many of them described a trend towards being called out increasingly often just before the end of a shift.
I spent a day with the Hampshire ambulance service and witnessed some of the problems at first hand. The pace was constant and we were lucky that nothing too horrific happened. However, one ambulance man said: "The problem is, if we have a death or something unpleasant, we are often straight on to the next job. Sometimes you just need a quiet quarter of an hour to help to come to terms with something. If you can't do that, the stress just builds up and there are an increasing number of personnel suffering from stress-related illnesses."
The ambulance men and women in Hampshire were also universally scathing about the new command and control system; the falling standards were partly attributed to it. It is worth mentioning some of their concerns. The system looks very good. The ambulances keep in touch with the control centre by means of a satellite navigation system. The computer operators in the control centre can in theory see at a glance which ambulance is closest to any emergency. Unfortunately, back in the ambulance, the system is not very high tech. The ambulance is informed of the address of the emergency and given a page number and rough grid reference, such as A4, from the appropriate Ordnance Survey map book. Once the ambulance is mobile, the navigator has to trace the journey by turning over pages of the book. There is no ambulance navigation system. I have used those OS books myself, and it is not easy to work out a long distance when one has to turn over a number of pages.
In addition, the crews are no longer in radio contact with one another. That might not sound like much of a problem, but it means that ambulance crews can no longer help each other out. Previously, there were frequent occasions when an ambulance crew could point out to control that its ambulance was better placed to respond to a call than that of the designated ambulance. The system does not always take into account problems such as one-way systems or motorway hold-ups. Also, if an ambulance is dispatched slightly off its usual patch, an ambulance man with local knowledge might be able to supply additional verbal directions, which could be the difference between life and death. Another aspect to the lack of communication is that, on occasion, a crew will have prior knowledge that a potential patient could be dangerous or abusive. They might even advise police
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back-up before entering a property. A way of communicating such information seems to be missing from the new system.
I witnessed some of the problems at first hand. On one occasion, the control centre thought that we were in Winchester, when we were in fact in Southampton. That was closely followed by my crew's returning to base, only to cross the path of an ambulance going to an emergency, travelling in the direction that we had just come from. We should have been directed to that emergency, but were not, and the crew's response was, "At least you have seen it for yourself now." I am glad to say that the trust has now acknowledged some of the issues relating to command and control and has spent time and money on further training for staff.
Other issues relate to a lack of consultation and frequent references to a top-heavy management structure. Recently, ambulances have been deployed to strategic points around the county in an attempt to improve response times. Theoretically that is a good idea, but the knock-on effect on the staff is that, in the rare event of a short break, they must sit in a cold, uncomfortable ambulance with no access to refreshment.
When I visited the ambulance station, staff were also somewhat demoralised because the response times had not then been published for some months. Conspiracy theories abounded, but the common response was, "The times must be really bad now; otherwise, they would be put up on the notice board."
Mr. Philip Hammond: Will the hon. Lady clarify something that she said? At the outset of her remarks, I think that I heard her say that in rural areas a 14-minute response for category A was acceptable. Will she confirm that Hampshire Ambulance—a rural service—is targeting an eight-minute response time across the county?
Sandra Gidley: I think that I said that the response time was 19 minutes for a rural area for 95 per cent. of calls. The eight-minute response time is for the new core categorisation, which I shall clarify later.
There was a problem, because the new command and control centre was installed shortly before the ambulance service moved towards core prioritisation. That prioritisation means a change in targets, and I wholly support the Government's aim in establishing new targets. The new system means that calls are now categorised. Category A calls are emergency or life-threatening. The new standard requires that, by 2001, ambulance services should reach 75 per cent. of category A calls within eight minutes. Response times for other categories remain unchanged.
How is the Hampshire service doing now? In March 2001, the category A response figure for the county was 43.62 per cent. However, for the Southampton and South West Hampshire health authority, which covers the bulk of my constituency, it was only 37.94 per cent. Over the past month, there has been an improvement, and it is only fair to acknowledge that the movement is in the right direction. The latest figures are 53.6 per cent. for Hampshire as a whole and 48 per cent. for the Southampton and South West Hampshire health authority.

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The fact remains that those figures fall well short of the required target of 75 per cent. This year, Hampshire Ambulance has managed to secure the extra funding that it has been seeking for the past two years. A visit from the NHS executive team resulted in a confirmation that the working practices were not at fault, the case for additional funding was strong and the money should be found from the county's health budget.
Securing that funding has been a problem in the past, and has been something of a hit-and-miss affair. I have been told that the health authorities do not purchase to the targets. North and Mid Hampshire health authority is widely known to be undergoing financial difficulties, and in the past would have funded only 90 per cent. NHS trusts in Southampton and Portsmouth purchase services at a 95 per cent. level.
That leads me to some fundamental questions about the way that the nation's ambulance services are organised. Is it right that we use an arcane system of funding whereby the ambulance authorities have to go cap-in-hand to each of the health authorities in their area? Health authorities already have a hard enough time balancing budgets and setting priorities. It is simply not right that an ambulance service will not necessarily receive the amount of money that it requires.
There appears to be no nationally agreed formula for working out the desired level of ambulance provision for any area. There is a carefully worked out formula for fire service provision, so it seems logical that the same sort of exercise should be undertaken in respect of the ambulance service.
Dr. Peter Brand: Does my hon. Friend agree that, if we are to have a national formula, it should be funded? The Home Office has set a formula for the Isle of Wight fire brigade, but the standard spending assessment from the Department of the Environment, Transport and the Regions falls short of the Home Office figure by about £1.25 million.
Sandra Gidley: Yes, there should be funding to meet the identified need.
Just as there is no national standard for ambulance provision, it is regrettable that there appears to be no single body to which the disparate ambulance services are accountable. Currently, each ambulance service decides many of its own procedures and protocols. That means, for example, that if a patient who needs a tracheotomy keels over on the Hampshire-Wiltshire border, we must hope that the ambulance comes from Wiltshire, because Hampshire ambulance men are not permitted to carry out that procedure. Similarly, there are variations throughout the country in the types of drugs that paramedics are allowed to administer. Surely it is time to introduce a set of national guidelines on all those matters. It appears that there are no mechanisms in place for sharing practice and spreading best practice—something that is done wall in other areas of the health service.
The question is how best to achieve that aim. Many of the staff to whom I have spoken believe that the ambulance service should be accountable to the Home Office and should work more closely with the fire service. I am not advocating that that step should be taken here and now, but more accountability should be
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demanded by the health service. In addition, ambulance men would like their conditions of service to be more closely allied to those of the police and fire services because they feel that they are a Cinderella emergency service—an expression that I have heard repeated many times.
To return to Lockerley, have things got any better during the past year? A letter from Frances Hanks, parish clerk of Lockerley parish council, to the director of operations at Hampshire ambulance service refers to an incident on 8 December when a woman
"made an emergency call at 8.30 am when she found her husband and thought he was dead. She gave specific instructions"
as to how to reach her property, and the ambulance arrived between 9.5 am and 9.10 am—
"definitely over 30 minutes and probably as long as 40 minutes. The ambulance came from Hythe and told her all they were given was a grid reference 'which didn't help at all.'"
On 4 March,
"A GP call was made for an ambulance…The ambulance drove past the property and was found circling Top Green. The ambulance had to be redirected by a lady walking her dog. (Unfortunately the lady—
Mrs. X—
"lost her husband to a heart attack last year, when she had to wait over 30 minutes for an ambulance to arrive. As you can imagine, this incident caused her further distress)."
On 7 March,
"An emergency call was made at approximately 9.15 am by…the proprietor of Lockerley Stores…The ambulance arrived at 10 am, 45 minutes later."
So the situation is not getting any better. Unfortunately, despite the fact that the letter was written on 9 March, there has still been no reply, which is less than reassuring.
However, my main concern is that constituents who live in rural areas will always fall within the 25 per cent. of the population who can expect a response time of more than eight minutes. It is the responsibility of all of us to ensure that people are not penalised just because they happen to live in a rural area. It is simply not good enough to trot out the tired old argument that they choose to live there knowing the risks. We have a duty of care to everyone and should be providing that care.
Mr. David Chidgey: Does my hon. Friend agree that plans to regionalise the ambulance service, so that there is one centre of control for most of the south-east, will only make the disparity between rural and urban areas greater? For example, if the county of Surrey were in the same organisation as Hampshire, there would be a gravitation of resources to the critical mass of the urban areas of Surrey at the expense of rural areas in Hampshire.
Sandra Gidley: That is a concern. I will address it later, but bigger does not necessarily mean better, and I remain unconvinced that that will be the case with ambulance services.
Mr. Hammond: The hon. Lady talked about her rural constituents always being in the 25 per cent. Who would have a response time of longer than eight minutes. The

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Government's target is that, by 2003, 90 per cent. of category A calls will receive an ambulance within eight minutes.
Sandra Gidley: I was not aware of those targets; perhaps the Minister could clarify them, but I thought that the 95 per cent. target related to a 19-minute response time. I hope that I was wrong.
There are new problems associated with the measures that are being introduced to reach response targets, specifically with the use of rapid response vehicles. They are crewed by one person only, and the aim is for that paramedic to arrive within eight minutes—so that the targets are reached—to stabilise the patient. However, because a rapid response vehicle then requires the back-up of a fully manned ambulance, the system is heavy on staff. If it saves lives, every penny will be well spent. However, what assessments have been made of the various ways of dealing with emergencies? Are overall outcomes better when a paramedic rapidly arrives on the scene or when transport to hospital is regarded as a priority? Those are fundamental questions, to which I have as yet been unable to find the answers.
I ask those questions because of a recent highly publicised case in Havant, which illustrates the problem. A motor cyclist was injured and a paramedic arrived—17 minutes later, although that is not the point in this case. A fire crew were already there and had administered first aid, but the patient then lay waiting in the road for another 30 minutes as his condition deteriorated. All ambulances in the area were tied up, so the firefighters took the decision to transport the injured motor cyclist in the fire engine. Obviously, fire engines are not designed for patient transport, and one fireman had to kneel on all fours to support the stretcher on his back, while a second fireman sat on the floor to hold the stretcher and prevent it from moving. If that does not illustrate the fact that Hampshire ambulance services are overstretched, I do not know what will.
Hon. Members should not be lulled into a false sense of security by convincing themselves that that story was a one-off. I have been told of several incidents in which firefighters have ended up either driving an ambulance or attending to a patient in the back of one; such incidents are almost always as a result of a singly manned ambulance arriving at the scene. We all know that ambulances should have two ambulance men on board.
Coincidentally, I picked up a copy of the Andover Advertiser yesterday, which had the front-page headline, "Ambulance crisis looms". I notice that the right hon. Member for North-West Hampshire (Sir G. Young) is present, and I expect that he will want to elaborate on this. The first paragraphs of the story say:
"Andover firefighters are becoming increasingly concerned about the time it's taking ambulances to arrive at incidents. They say financial limits imposed on Hampshire Ambulance Service are putting firemen under increasing pressure. But the ambulance service is denying there's an ongoing problem.
'We're frustrated and angry,' said Lud Ramsey, Andover's Fire Brigades Union representative. 'Ten years ago we would have attended fire calls, road traffic accidents etc. and we knew the ambulance would be only minutes behind us.'"
I have heard from a high level in the Hampshire fire authority that those incidents are being repeated in towns throughout the county. Indeed, the fire service is
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facing demands from firefighters for more first aid training and is considering whether defibrillators should be standard fire engine equipment. That is because firefighters feel that they can no longer rely on ambulances to arrive quickly enough.
When I was out with the ambulance service, one incident brought home to me the fact that ambulances are sometimes called out for what can only be described as non-urgent reasons. A letter in the Romsey Advertiser from Liam Sizer, the southern area convenor of Unison, sums that up. It says:
"Calls to people with rings stuck on fingers; to people with minor cuts often needing no more than a small Elastoplast; to people with toothache, earache and backache; to people who have been feeling 'unwell for a few days and it's not getting better' (I could go on, but it would become boring). These people account for such a large proportion of 999 calls that they are the biggest cause of the delays experienced by patients who really do need our speedy attention.
Finally, could I please ask that all people, notwithstanding where they live…make sure that their house name or number is clearly visible as close to the road as possible."
I urge the Minister to consider running a public information campaign in a similar fashion to that aimed at dissuading people from calling out their general practitioner for trivial reasons. Abuse of the system costs money and lives.
The final item on the agenda is the proposed merger of the Hampshire and Surrey ambulance trusts—mentioned hon. Friend the Member for Eastleigh (Mr. Chidgey)—which will shortly go out to public consultation. To show my linguistic roots for a moment, let me say that the merger strikes me as a completely barmpot idea if ever there was one. I have not seen the final consultation document, but the following points need to be addressed.
Bigger is not necessarily better, but often results in an extra tier of management. Cynics have pointed out that, before the merger's announcement, the Hampshire ambulance trust board mysteriously increased in size and most new appointees were people who had recently retired only to return suddenly. Many people regard that as a cynical ploy to appear to be cutting jobs when, in reality, a few jobs were created for a short period to provide a cushion. The reality is that most long-serving people will keep their jobs under the new scheme.
Change is disruptive. Hampshire is experiencing problems in trying to get to grips with the new control system and is still nowhere near achieving the targets. Further disruption will result only in a worsening of response times in the short term, with no guarantee of an improvement in the long term.
Many people in the ambulance service regard the merger as a done deal, because it has been said that the status quo is not an option. Although I am here today highlighting problems with the status quo, I am still not convinced that there are any advantages to the merger. Surrey and Hampshire are not natural partners. Hampshire looks more readily to Dorset and Wiltshire, but those counties are now officially in the south-west, so we cannot consider a merger with a more like-minded county. The huge problem is that Surrey is an urban trust with urban response targets, but, as has been mentioned, Hampshire is rural; so what targets will the new trust have? I am sure that Surrey will not settle for a diminution in service, but it will cost a considerable

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amount of money to bring Hampshire up to Surrey's standards. Hampshire is not even meeting its own standards at the moment, so heaven help us if we have to achieve higher standards.
In addition, reorganisations cost money. Who will pay for reorganisation? Hampshire secured extra funding this year only because it demonstrated that there was an operational need for it, but that need does not cover the likely costs of reorganisation. Why is the merger proposed when Operational Research into the Health Service conducted a survey two years ago on the regional office's behalf and concluded that there would be no benefits in a merger? There will also be pay differentials, as the two trusts are paid differently. I do not believe that recruitment and retention will be improved.
If the Minister is minded to consult on the scheme, I ask that the consultation be real and, if opinion is against it, for her to take note of that. Will she also make clear the cost to the public purse of the proposed administrative upheaval?
The speech that I have made today may sound somewhat negative. Most people who call for an ambulance get one quickly, but the problems that I have highlighted show that the system is under considerable strain. There needs to be serious consideration of Hampshire Ambulance Service NHS trust and other trusts to try to sort out some of those problems.
It would help if we had a set of national standards and guidelines that were matched by funding that automatically meant that those standards were attained. Clear accountability is also needed, because one thing that I have noticed in all this is that no one seems to have put their hand up and said, "It's our fault."
9.59 am
Sir George Young: The House is grateful to the hon. Member for Romsey (Sandra Gidley) for the opportunity to debate the ambulance service in Hampshire. As she says, it is a topical matter in my constituency. Last week's edition of the Andover Advertiser, the voice of Andover, led with the story to which she referred. She quoted extracts from Caroline Inman's report, in which a fire brigade representative said:
"Ten years ago we would have attended fire calls, road traffic accidents etc and we knew the ambulance would be only minutes behind us.
Now, we're having to get more and more of our staff trained in emergency first aid".
I visited the Andover ambulance station in my constituency, the command and control centre in Winchester, and NHS Direct, which I understand is run by the ambulance service. Like the hon. Lady, I have a high opinion of those who are at the sharp end as well as those who are providing back-up services, those who are managing the command and control centre and those who are trying to run the service.
The debate that the hon. Lady initiated is symptomatic of a broader debate, which confuses my constituents and should worry the Government. We are coming to the end of a Parliament in which the health service has been a Government priority. We have all seen the NHS plan that was published last July, and we have seen the Prime Minister on the Frost programme,
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promising more resources. Many of us were in the House last November when the Secretary of State made a statement about more resources for the NHS. Yet the rhetoric does not match the reality of the everyday experience of my constituents.
The hon. Lady mentioned some worrying incidents. The delays for out-patients are now worse than they were. For example, in the third quarter of 2000, 1,058 out-patients were waiting 26 weeks or more, which was up from 548 a couple of years earlier. People are waiting for wheelchairs. Someone waiting for a wheelchair in my constituency may receive a letter from the Winchester and Eastleigh NHS trust that states:
"Equipment will either be refurbished or new. Owing to budget control it is not possible to order all new equipment immediately … If you have not heard from us regarding provision of this equipment after four months please contact this office, when it may be possible to give the anticipated time before the items can be provided."
My constituents are confused. The reassurances that they hear from Ministers do not match what happens in their everyday lives.
The hon. Lady mentioned the resources that are available to the Hampshire ambulance service trust, and I want to focus on that for a moment. As she said, the trust receives resources from the three authorities for the area—the North and Mid Hampshire NHS health authority is the one for my constituency—which are resourced according to a formula. In my view, the formula is unfair. The NHS ambulance service in Hampshire is under pressure because the resources for the county as a whole are less than they should be. For every £100 of NHS resources allocated nationally, my constituents receive £80. We are deemed to be 20 per cent. healthier than the rest of the country. I do not believe that that is the case. Not all deprived people live in deprived areas. More than half of the most deprived individuals in the country live outside the most deprived 20 per cent. of wards. Any resource allocation to health authorities and ambulance services that targets only the most deprived wards will miss more than half of the most deprived people.
In April last year, the Minister set up a panel to scrutinise a document entitled "Meeting the Challenges", which was about funding for Hampshire health authorities. The panel was appointed to examine proposals aimed at achieving savings of £13 million in the health service in Hampshire. That panel said of the formula that funds the Hampshire ambulance service that
"The National Funding Formula for Health Authorities is at the heart of the problem. This is a challenge for central Government … North and Mid Hampshire Health Authority receives 80 per cent. of the national needs assessment. Panel members felt strongly that this was too low."
The next remark is especially interesting.
"We heard no evidence to support such a large reduction in the national needs "norm". What is more, we were told of both urban and rural 'pockets of deprivation' within the Authority, where an 80 per cent. allocation was arguably inadequate … This challenge lies at the door of Government but the authority should fight for it, too."
The formula is being looked at, but over a rather leisurely time scale and there is no prospect of imminent help for Hampshire, which needs a more equitable distribution of resources. That shortage of resources is

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at the heart of some of the issues raised by the hon. Member for Romsey. In a letter dated 20 July 2000, the chief ambulance officer wrote:
"Unfortunately, in common with many ambulance services across the country, we were unable to secure adequate additional funding to meet our identified needs."
That matter worries the Winchester and Central Hampshire community health council. General practitioners in my area have also raised the question of the ambulance service not arriving within the response time targets. There are possible plans to centralise paediatric intensive care at Southampton hospital. That may make good medical sense, but it will put a lot of pressure on the ambulance service to transfer those vulnerable babies. The CHC and the local MPs will keep an eye on that as it will mean an increased demand for the ambulance service and more funding will be needed if that is to be secured.
Mr. Hammond: I am sure that my right hon. Friend would want to note that the CHC will keep an eye on it for as long as it can, given that the Government are committed to abolishing it.
Sir George Young: My hon. Friend brings me back to our debates in the Committee stage of the Health and Social Care Bill. I hope that the House will soon have an opportunity to revisit that. I hope that the CHCs can continue to scrutinise the delivery of health care in Hampshire for some time to come.
When I visited the control and command centre at Winchester I learned that it was settling down but that it had had one or two teething problems, which may be behind some of the incidents that we have heard about today. It would be helpful if the Minister could give us a clear statement about where we are on reorganisation. It has been a diversion of management effort over the past few years to have the future of the ambulance trust put into question. There has been a lot of turbulence in Hampshire with the abolition of some trusts and mergers of others. I hope that the Minister will not go ahead unless she is convinced that this will directly alleviate some of the problems that have been mentioned this morning.
There is one issue on which the Minister may be able to shed some light. I understand that, in some parts of the country, the ambulances are no longer based at the ambulance stations but are sent to outposts in various parts of their area where it is felt that accidents are likely to happen. I can see that that would reduce the response time, but in my constituency ambulances are posted to a junction of the A303 and the A34. That may indeed be an accident site, but we have only two ambulances on duty and if one is permanently stationed at that junction it leaves the citizens of Andover rather exposed. Is there any Government guidance on how ambulances should be positioned?
I know that the Minister she will refer to the huge extra sum of money that she asserts has been made available to the health authority. When headline national increases of 8.5 per cent. Were announced last November, I wrote to my health authority to find out the reality. Unsurprisingly, its perception was not quite as rosy as that of the Minister. In his reply, the director of finance at the health authority said:
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"Needless to say, these headline figures only give the tip of the iceberg."
He added that the general increase, estimated at 4.9 per cent., was intended to meet the pressures on pay, prices and the cost of implementing the National Institute for Clinical Excellence recommendations. Significant cost pressures will need to be addressed, including a 2 per cent. rise in pension costs, the costs of implementing changes to junior doctor hours and the underlying financial deficit of the local health economy.
Some of the increase is ring-fenced to meet targets set by Ministers. If the ring-fenced and other money is deducted, it will be impossible significantly to improve the service. The penultimate sentence of the director of finance's letter says:
"There are many significant calls on this funding, particularly locally where there is an underlying financial deficit. Careful planning, phasing and prioritisation will be needed to deliver affordable and modern health services for local people."
Against a background of some £30 million of savings, some of which will affect patient care, I asked whether, because more money was coming into the system, those savings could be abandoned. The response was that they could not because when plans for the savings were drafted it had been assumed that the extra money announced in November would be forthcoming. I quote the director of finance again:
"as the funding announced for next year is in line with the assumptions underpinning 'Meeting the Challenges', the proposals"—
the proposals to reduce services—
"remain valid."
Will the Minister make clear whether the reorganisation of the health service in Hampshire will lead to further turbulence? What progress is likely to be made on reviewing the funding formula, which lies at the heart of the issues raised in this morning's debate?
10.10 am
Mr. Peter Viggers: I am grateful for the opportunity to speak briefly in this important debate on the Hampshire ambulance service. I recall the days of the original arrangements for the service in my Gosport constituency. Two ambulances based at the Bury Cross depot were responsible for transporting patients to and from the local hospitals and for undertaking transfers for out-patients. It was a locally based service that was well received. I had few complaints and I would like to add my tribute to the ambulance workers who undertook those services then and now. No one enters the ambulance service without a sense of vocation, which I discovered whenever I talked to ambulance workers in my constituency or in Hampshire generally.
The old arrangements could not continue into our modern, high-tech age. The new arrangements described today are now organised at the command and control centre in Winchester. They are intended to be much more efficient, but worrying teething difficulties have occurred. I recall a constituent telling me that an ambulance was called for her husband who had suffered a heart attack. It came not from Gosport, but from Hayling island, some distance from the constituency. The ambulance was delayed and, because the driver did not know the route into Gosport, the patient's wife had

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to talk him through it. The patient's daughter was sent out into the road with a torch to guide the ambulance in. Unfortunately, the patient died.
That is not the only case. The reorganisation and restructuring has meant that ambulances have had to come into my constituency from a considerable distance away and, because the drivers and crew do not know their way around the area, unacceptable delays have occurred. We must all hope and trust that the new system described by the hon. Member for Romsey (Sandra Gidley) and by my right hon. Friend the Member for North-West Hampshire (Sir G. Young)—the high-tech control and satellite navigation systems and the upgrading at Winchester—will produce a more efficient system in the longer term. I am grateful to the Hampshire ambulance service for providing one extra ambulance in the Gosport area to take account of the extra demand.
I shall not repeat points already well made by the hon. Lady and my right hon. Friend, but I want to raise two further issues based on my experience of dealing with the Hampshire ambulance service and local circumstances in my constituency.
The Government have been slow to keep the Hampshire ambulance service abreast of developments in merger discussions and changed funding systems. The Government were slow and unresponsive to local concerns. It took two years for the ambulance service to clarify the Government's thinking on the proposed merger and refunding. Members of Parliament should not have to intervene in such discussions. I pay tribute to the Minister; I raised an issue with her in the House after a Division, which her office followed through. I am grateful for that first-class response. However, there seems to have been fuzziness in the lines of communication between the Minister's Department and the Hampshire ambulance service, which I hope can be clarified.
My constituents would not forgive me if I did not make the point that the range of difficulties created in the Gosport peninsula and south Hampshire have been seriously worsened by the Government's announcement that they propose to close the Haslar hospital in Gosport. It was originally announced that the closure would not take place before 2002, but its accident and emergency unit has already closed. We have fought the closure with absolute determination; 22,000 people came on the march in January 1999, which is thought to be the largest march in protest against a hospital closure. Because of our fight, the closure will not take place before 2007, or even later. The private finance initiative bid for Queen Alexandra hospital, which would enable it to take on much of Haslar's work load, has again been delayed. We therefore feel confident that we are winning our campaign. The number of out patients who can be seen at Haslar hospital is to be increased from 55,000 to 60,000; Haslar also has an accident treatment centre. However, that does not diminish the fact that the closure of its accident and emergency unit has made life much more difficult for the ambulance service in the area. Ambulances now regularly have to mix with the tidal flow of traffic out of Gosport in the morning and back into the town in the evening. If the Government rethink their plans on Haslar—as they must—the pressure on the ambulance service will eventually
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decrease, to enable it to provide a better service for the people of south Hampshire. We will continue the campaign on that issue.
I pay tribute to the hon. Member for Romsey for raising the debate and to my right hon. Friend the Member for North-West Hampshire for his informed contribution to the discussion. I add a plea that reorganisation and turbulence be diminished and that those responsible for the ambulance service in Hampshire be given the funding and the decision-making capacity that will enable them to continue to carry out their work.
10.18 am
Dr. Peter Brand: I congratulate my hon. Friend the Member for Romsey (Sandra Gidley) on initiating the debate. We all expect the ambulance service to be in place; we value it when we need it, but forget about it for the rest of the time. That is a tremendous mistake. As a practising doctor who does the odd bit of emergency cover, I am always more relieved than even the patient to have the support of a professional ambulance crew. The service has developed its role over the past 20 or 30 years in an amazing way and has a fantastic standard of training. As has been highlighted in the debate, extra stress is being put on the professionalism of a group of people who want to deliver a good service—I do not know a single ambulance man or ambulance woman who is not dedicated to that task.
Some of the organisational problems suffered by Hampshire may affect the services on the Isle of Wight. Having made a more general point about the conditions under which we expect ambulance personnel to work, I would also argue that those personnel are undervalued. It is partly a matter of wages, but it is also a matter of working conditions.
The right hon. Member for North-West Hampshire (Sir G. Young) mentioned the strange practice of putting ambulance personnel on standby in car parks. I would like to know whether that has made a difference to response time and the survival rates of patients. It certainly makes an enormous difference to the way in which ambulance personnel are valued. Proposals to close the ambulance station in Ryde—the second largest town in my constituency—and to base the ambulance personnel in a car park somewhere on the downs cannot be right for the working conditions for those involved.
I would also urge the Government to reconsider the ambulance services' request for better and more appropriate protective clothing. Luckily, the risk of involvement in stabbing incidents is not high in Hampshire, but difficulties can arise where there is alcohol and disruption. If individual ambulance personnel would like the protection of lightweight, protective clothing, it should be made available. Financial considerations should not interfere with that.
Much was said about the loss of local knowledge among ambulance personnel. I would like to touch on that, because we have had experience of what happens when one tries to be efficient and amalgamate services to create a larger unit. We have seen it in the case of NHS Direct—it takes about 10 minutes to get through to the service, another 10 minutes to set out the story and then it often takes another 10 minutes to find the appropriate

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person to deal with the patient's problem. Unfortunately, quite frequently the message that comes back from NHS Direct via the ambulance service to the doctor on call is incomplete. On two occasions, NHS Direct has not passed on to me telephone contact numbers for patients. It is essential to have a way of communicating with people. Such failures create duplication and delay.
In our region, we also have experienced the centralisation of the police control room at Netley. As far as the Isle of Wight is concerned, it has been a disaster. People are not sure whether they should be dialling 999 or getting in touch with the police control room. Those working in the police control room take an enormous amount of time to pick up the phone, and they often say, "This is not an emergency for us, ring your local police station tomorrow," not knowing that that local police station is not manned, and leaving people to deal with an answerphone. I would not want that sort of pattern to be repeated in the health service.
There is evidence that, when organisations get bigger, although that may result in efficient systems that can be tracked, people get lost in them. Before decisions are made on regional amalgamations, especially in respect of the ambulance personnel control room, I hope that the Minister will wait to see what the Audit Commission says about NHS Direct, to see whether that kind of regional structure is the most appropriate. She should also speak to those who are experiencing the effects of centralisation in the police control service.
Mr. Hammond: The hon. Member for Romsey (Sandra Gidley) raised two issues relating to organisational structure: whether ambulance services should be placed under the control and responsibility of the Home Office, and what the services' relationship with the fire brigade should be. The hon. Lady stressed that she was not advocating any particular course of action with respect to those issues. As official health spokesman for his party, can the hon. Gentleman tell us what his party's position is on those issues?
Dr. Brand: I am grateful for that question, because I believe that the ambulance service should be an integral part of the national health service. We also believe that the NHS should be an integral part of local democracy, as should the police and fire services. The ambulance service should work with local doctors who work out of hours and with local casualty departments, so that local flow patterns can be established.
The important point that the hon. Gentleman is making is that the emergency services must work together. I have been disappointed that successive Governments have tried to improve efficiency by making the control systems and units of the ambulance service, police and the fire brigade bigger, but retaining their isolation. That may produce a regional fire brigade, ambulance and police service, but we need an integrated emergency service, which could also include civil defence and out-of-hours social services provision. In that way, each locality could provide an appropriate response to an emergency. That would eradicate some of the problems that have been highlighted during the debate, such as that of people who inappropriately
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contact the ambulance service. We cannot blame people for doing that if they do not know whom they should contact. NHS Direct should be able to cope with that problem, but, in my experience, it does not always get it right. I hope that it will do so in time.
It would be much better if local services were integrated. Hampshire is almost too big for that, but the health authority areas should be able to integrate some of their services. Some services would need to be town or city based, whereas others are obviously more rural. There are different response requirements in different places. Rural areas tend to be more self-sufficient. That does not mean that they should not receive a five-star service, as my hon. Friend the Member for Romsey said, but local general practitioners are often more responsive to out-of-hours work and there is more collaboration between the ambulance service, medical and even pharmaceutical services in rural areas.
This is a valuable debate, which is not only about Hampshire, but about how the Government see the interaction between the people who need the emergency services and those who provide them. I hope that they will not take the bean-counting route of "bigger is better" and look only to make efficiency savings in the cost of telephone operators, but that they will have regard to the quality of service that will result from the structures that they are considering.
I would be horrified if ambulance services on the Isle of Wight were forced to amalgamate with those in Hampshire because amalgamation of the police service has not been good for us. There is a risk that we will do just as badly from an amalgamation of the fire brigades, and I believe that amalgamation of the ambulance services would be a disaster.
10.28 am
Mr. Philip Hammond: I, too, congratulate the hon. Member for Romsey (Sandra Gidley) on securing the debate. Like accident and emergency services, ambulance services are a matter of great concern to all our constituents and strike at the heart of the population's confidence in the service provided by the national health service. We must keep our ambulance services under constant scrutiny. Indeed, a couple of months ago, the Minister replied to a debate that focused on ambulance services in London, but in which some wider issues were raised. Some of those issues have been raised again today, and I hope that the Minister has some more general comments to make when she winds up the debate.
My hon. Friend the Member for New Forest, West (Mr. Swayne) would have liked to attend the debate but, unfortunately, he is detained by the Special Standing Committee that is considering the Adoption and Children Bill, so I am here instead. I thank my right hon. Friend the Member for North-West Hampshire (Sir G. Young) and my hon. Friend the Member for Gosport (Mr. Viggers) for their lucid and well-informed contributions to the debate.
My right hon. Friend focused on ambulance trusts and their funding, paying particular attention to the Hampshire ambulance trust, in the context of the other pressures on health authorities. We must always remember that the Government, who exhort and set targets, set them by the score. There are other pressures

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on the limited purses that are the responsibility of the people who determine the funding of the ambulance trusts. Rightly or wrongly, the perception of my right hon. Friend's constituents, like that of my constituents in Surrey and those elsewhere in south-east England, is that funding formulas do not take into account the additional cost pressures on health providers in the relevant areas and that they underestimate the pockets of deprivation in areas that are relatively affluent overall.
I was grateful to my right hon. Friend for raising the issue of community health councils and their important role in scrutinising ambulance services' performance. The Government are committed to the abolition of community health councils—a decision that all the Opposition parties in this Parliament oppose and will continue to fight. The example of CHC involvement in monitoring ambulance services is interesting because it reveals a particular weakness in the Government's proposals to replace CHCs with patients forums.
Under the Government proposal, a patients forum will of course be associated with the Hampshire Ambulance Service NHS trust. However, ambulance trusts cover wide areas—a whole county in Hampshire's case, but even larger areas for some trusts. It is difficult to see how a countywide monitoring body, or one that is multi-countywide, will provide the focused scrutiny that CHCs have been able to give. That is another reason to add to the catalogue of reasons for the Government to reconsider their decision to abolish community health councils.
I was grateful to my hon. Friend the Member for Gosport for highlighting the difficulties of communication that seem to have occurred during the progress of talks about funding, and, in particular, the merger proposals affecting Hampshire ambulance service. The point is important and it goes to the heart of some of the questions about morale, recruitment and retention.
My hon. Friend also made an important point that I had not heard before, in drawing attention to the effect of the apparently inexorable process of consolidation of hospital services into ever-larger units. That process is driven not just by economics but by the royal colleges' concerns about patient safety and the need for minimum levels of throughput for procedures to maintain safe practices. Such consolidation will affect the need for ambulance services. It is obvious that, as hospital services are provided in ever-larger units and patients must travel increasing distances to use them, ambulance services will have to expand faster than the health service overall.
Dr. Brand: Does the hon. Gentleman agree that the process will not have an even impact across the country? Some areas will be much more affected by that desirable way of providing services in certain fields of expertise. Some isolated rural and island areas will be very much disadvantaged.
Mr. Hammond: The hon. Gentleman is obviously right to say that the phenomenon is not evenly distributed, but it is still important. It is perhaps related to another point, made by the hon. Member for Romsey. She asked whether ambulances are considered
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primarily as a mode of transport to hospital, or as mobile treatment areas in which treatment is begun where the patient is picked up. That is part of the broader issue of how we create proper paramedic and ambulance services in a world where the distribution of hospitals and specialist care centres is different from that of 10 years ago.
Sandra Gidley: Does the hon. Gentleman agree that as part of the "re-look" at the ambulance services we should consider the fact that ambulances are far too often used as an up-market means of transporting an old lady from one hospital to another, when there is probably no need for a trained paramedic and a back-up person? Is there not a case for a total review of the services provided by the ambulance service to identify more clearly the calls that need to be responded to by paramedics? Should we not also consider increasing the transportation side of the ambulance service in another manner? At the moment, all these services tend to be put into one big pot.
Mr. Hammond: The hon. Lady is right. The services should not be treated as being in one big pot. To be fair, many ambulance services separated their patient transport services—and they are now covered by separate contracts. However, she raises an important point. I hope that the Minister will say more about it.
I am confused about whether ambulances should get patients to hospital as quickly as possible or begin treatment at the scene. I have seen data that send conflicting signals about which approach gives patients the best chance of survival and recovery. It would be interesting if the Minister could update us about current thinking, and tell us what the indicators are from the latest available data and how she therefore expects ambulance services to develop. I suspect that the consolidation of hospitals into ever-larger units—certainly for specialist treatment—will continue. That is key to establishing patient confidence in the service.
People are conscious of where their nearest hospital is. However, anyone who looks into how the system works will quickly become aware that a patient is not necessarily taken to the nearest hospital. To use a Hampshire example, a patient suffering a head injury following a motor accident in Winchester will not be taken to the hospital in Winchester; he will be taken past its door to the hospital in Southampton because that is where head injuries can more properly and appropriately be dealt with. The matter is more complex than locating the nearest hospital and thinking of ambulances as a means of getting from A to B. Perhaps we have to take one step backwards in order to take two forward in thinking about the future configuration of ambulance services.
The hon. Member for Romsey has highlighted specific factors and issues relating to Hampshire, but in the process has touched on broader issues that relate to a much wider area. One such matter is the rationalisation and regionalisation of services in the south-east and the debate about the merger and reorganisation plans for ambulance services in the region, particularly the possibility of merger between the Surrey and Hampshire ambulance services. My right hon. Friend the Member for North-West Hampshire asked the Minister about that. I, too, should be grateful if she would tell us the current state of play.

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My perception, as a Surrey Member of Parliament, is that Surrey is different from Hampshire in that its northern and eastern fringes are of a much more urban character. Its problems are more akin to those of the London ambulance service than to those of a rural one. Having said that, there is a degree of co-operation between Surrey and Hampshire ambulance services.
My hon. Friend the Member for Aldershot (Mr. Howarth) was in the Chamber earlier in the debate. He is not essentially involved in the discussion over Hampshire ambulance services. In his constituency, the majority of ambulance cover is provided by Surrey ambulance services under arrangements between the relevant health authorities. My hon. Friend believes that the arrangement works well.
Reference was made to the introduction of new technology for the Hampshire ambulance service. New technology often leads to teething troubles, but it is necessary to provide a modern ambulance service. It was, however, rather late coming to Hampshire, largely as a result of underfunding. Over the past two years, the Hampshire service has received only inflation-based increases, but demand—measured by the number of calls on the service—has risen by 8 per cent.
The Government set targets for the delivery of ambulance services and some money is passported through directly for the modernisation of ambulance services. The majority of the funding, however, comes from health authorities that face other huge pressures on their budgets. The health authorities that fund Hampshire Ambulance provide between 90 and 95 per cent. of the resources necessary to deliver the service. It is incumbent on the Government, when presenting and reiterating target figures, to address that issue. It is no good constantly reasserting the targets when adequate funding to meet them is clearly unavailable under current mechanisms.
Below-target response times are a widespread problem, but our debate on the issue has been confused. I shall clarify my understanding of the position and the Minister can correct me if I am wrong. Under the patients charter, the target for April 2003 is that for category A, life-threatening calls, an ambulance must arrive at the scene within eight minutes in 90 per cent. of cases. That information is set out in a bulletin from a website, which has just been printed out for me during our debate. That is my understanding of the Government's ultimate target. I assume that 75 per cent. Is an interim target for April 2001.
The most recent published figures demonstrate that by April 2000, all ambulance trusts bar one—Staffordshire—failed to meet the 75 per cent. target. Another year has passed and the figures will not be published until June, but I hope that the Minister can provide some information about the percentage of ambulance trusts currently meeting the 75 per cent. eight-minute target.
I am not optimistic. The direction of travel has been backwards, not forwards. As I said, only Staffordshire had met the target by April 2000, and even that was a static performance in relation to the previous year. Several others in the list—Sussex, Dorset, Two Shires,
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Kent, Bedfordshire, Hertfordshire, Isle of Wight, Oxfordshire, Gloucestershire, Hereford and Worcestershire and West Country ambulance services—actually went backwards. Hampshire went from a 52.8 per cent. response performance in 1998–99 to 44.5 per cent. in 1999–2000. The Minister told us today that, by March 2001, it had fallen further to 43.62 per cent. To what does the Minister attribute that dismal decline in ambulance service performance? Why has her Government allowed the service to deteriorate to that level when, for example, in the last year of the previous Government, Hampshire ambulance service was achieving a 53.2 per cent. eight-minute response? Given the figures, will the Minister revise the targets for 2003 downwards to reflect reality or will she, as the Government have done with their other targets in the NHS plan, simply ignore what is happening in the real world and continue to spin the target figures, as though they were an achievable reality?
As the right hon. Member for Holborn and St. Pancras (Mr. Dobson), the former Secretary of State for Health, said, the Government
"raised people's expectations sky high and have not delivered."
They are playing a dangerous game with public confidence in the NHS and the ambulance service in particular. The Government should look long and hard at performance, take proper advice on the realistic targets that can be met by 2003 and ensure that the figures being circulated in the public domain reflect them rather than some unachievable aspiration.
10.46 am
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): I congratulate the hon. Member for Romsey (Sandra Gidley) on securing the debate. I note that she has visited the ambulances, as have many other hon. Members present. I sometimes wonder whether ambulances are the most visited part of the national health service. That is a tribute to them. We all engage in their services considerably. I am aware of the hon. Lady's interest in the NHS ambulance service and this is a timely debate on ambulances, not just in Hampshire, but across the country.
Hampshire Ambulance Service NHS trust provides services for the residents of three health authorities that cover the Hampshire area: North and Mid Hampshire, Southampton and South West Hampshire, and the Isle of Wight, Portsmouth and South East Hampshire. The trust covers an area of some 1,400 square miles and provides emergency and non-emergency services for around 1.5 million people. In addition to the urban and congested areas of Portsmouth and Southampton, it has some rural and sparsely populated areas including the New Forest. The trust has nearly 500 staff, 68 emergency ambulances and eight fast-response vehicles, and last year it handled around 86,000 emergency calls.
I am sure that the hon. Member for Runnymede and Weybridge (Mr. Hammond) will join me in taking the opportunity to thank all the staff of the Hampshire ambulance services for the tremendous work that they do, day in, day out. The hon. Member for Isle of Wight (Dr. Brand) was right to say that because of their reliability, we tend to be grateful on the days that we need them but there is a danger that we may forget their daily work. I want to reassure ambulance services

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everywhere that they are not forgotten. I hope that the extra investment and the development work in their role and function over the last few years will reassure ambulance services everywhere that, although formerly they could justifiably have been described as the forgotten service, that is not the case now. They play a vital role as part of the NHS family.
I was grateful that other hon. Members reiterated that, while it is an emergency service, the ambulance service is seen as an integral part of the NHS family and should remain so. The value of the work of Hampshire ambulance service is abundantly clear from the way that it has provided medical care in times of need such as the recent major chemical fire in Portsmouth. The Government have given a high priority to improving emergency response times to those patients who are severely ill or injured. Anyone reading the national service framework for coronary heart disease or the NHS plan will see just how much emphasis has been placed on the need for improved response time standards.
The hon. Member for Runnymede and Weybridge highlighted the function of ambulances. The question whether a patient should be just transported or receive immediate care varies, depending on the circumstances. We must get away from seeing the ambulance service as people carriers. They are highly trained paramedics who can fulfil important functions.
Mr. Hammond: I am not trying to make a political point, but I have seen data that have thrown into question the hypothesis that treating trauma patients at the scene and thus delaying their admission to hospital improves the outcomes for those patients. Does the Minister acknowledge that that is a genuine issue of concern, which should be investigated?
Ms Stuart: I certainly do, and I recently had discussions with trauma surgeons about the best way forward. However, for patients with cardiac arrest, there is no doubt that the quicker a paramedic arrives at the scene, the better. Even more to the point, we are investing heavily to provide defibrillators in public places—some 700, at a cost of £2 million—because the help that they provide does not require the presence of a paramedic.
I should like to resolve some of the confusion about the challenging national targets that we have set. Our expectation is that all ambulance services should respond to life-threatening emergency calls, which are generally known as category A calls, within eight minutes 75 per cent. of the time, irrespective of location. That target should be reached, whether the call is in the centre of London or in the most rural area. We must find ways to achieve it. I do not accept the argument that we cannot because there is a big difference between rural and urban areas. The solutions for meeting our expectations will be different in different areas.
Sandra Gidley: Will the Minister give way?
Ms Stuart: If I might make a little progress, many of the questions will be answered.
I would like to see the website that says that the Government have set a target of 90 per cent. by 2003. I am not aware of such a target. Officially, we have said
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that we want every service to reach the 75 per cent. target first, and then we will move on from there. That is important.
We want to ensure that ambulance services everywhere get to more patients in time to make a difference. That is not about creating league tables but about saving more lives. Clinical evidence shows that faster resuscitation, quicker heart shocks using a defibrillator, and the earlier delivery of clot-busting thrombolytic drugs can all make an important contribution to the effort to reach the demanding targets that we have set for saving more lives.
Since 1997, ambulance services have improved their response times by using a range of measures, including more staff and vehicles, faster activation, better matching of resources to demand, dynamic as opposed to station-based cover, effective relief levels and rotas, and flexible 999 responses. I emphasise the issue of where ambulances should be located. The ultimate aim is to get effective help to immediately life-threatening category A calls within eight minutes.
Developing new ways of fighting the war against heart attacks is very important, especially in the more rural areas where ambulance responses tend to take longer. First responder and community volunteer responder schemes buy time during the vital first minutes and until a fully equipped and crewed emergency ambulance arrives. In some areas, first responders work with the fire service. That is right and proper; the aim is to get people there quickly.
Across the country, NHS ambulance trusts answer and respond to more calls year on year. In the past five years alone, emergency 999 calls have risen by nearly 1 million—an increase of 30 per cent.—and the number of patient journeys has also increased.
Dr. Brand: I am fascinated by the Minister's comment that it is policy to allow the other emergency services to provide a service. I am totally in favour of that. However, will she speak to her colleagues in the Home Office who base fire brigade funding entirely on callouts to fires and do not consider any accident or emergency service that they might be providing?
Ms Stuart: We have discussions with our colleagues about those areas where the services work together, but it is not always funding alone that is the problem. Other concerns are whether people are trained and how they co-operate. I must put the record straight in relation to the hon. Gentleman's point about NHS Direct. His perception is that it takes 10 minutes to answer the call, 10 minutes to tell the story and 10 minutes to give the answers. He might have picked up on one incident where that happened, but the figures do not bear him out. The statistics show that NHS Direct in Hampshire answered 64 per cent. of calls within 15 seconds; it took 16,000 calls in March. There will be further improvements.
On Hampshire ambulance services, the national increase in demand has been reflected in Hampshire—
Mr. Hammond: Will the Minister give way?
Ms Stuart: I should like to make progress, because a number of questions have been asked.
Mr. Hammond: They have not been answered.
Ms Stuart: May I have the chance to answer them?
Against the backdrop of increased call levels, ambulance service response times have improved significantly since we came to power. A year ago, only one ambulance trust—Staffordshire—was meeting the required target, but it is expected that most services, including Hampshire, will be achieving it by the autumn. By March 2001, 14 services had reached the target.
Mr. Hammond: Will the Minister give way?
Ms Stuart: Very briefly, and probably for the last time.
Mr. Hammond: I am very grateful. The Minister asserts that response times have improved since the Government came to power. Can she explain, then, why the percentage of eight-minute responses in Hampshire in 1997–98 was 51.8 per cent., falling to 44.5 per cent. in 1999–2000? Those are Department of Health figures.
Ms Stuart: Overall and in whole areas, performances have improved. As I said, a year ago only Staffordshire was meeting the 75 per cent. target; now, 14 of the 32 services are meeting it. I expect at least 29, including Hampshire, to have reached the target by the autumn. I know that progress in Hampshire has been slower than anticipated. That is simply not good enough. Hampshire ambulance trust and the local health authorities know that, too.
What is being done to increase the speed of progress? At my request, the Department's winter and emergency services team recently visited the trust and examined its improvement plans to ensure that all obstacles to progress had been identified. The trust's plan includes recruiting and training 58 more front-line staff, adding 11 emergency vehicles, strengthening control and support functions and changing staff rosters.
Hon. Members have spoken this morning of the need for additional resources for ambulance services. We recognise that, and the Government are committed to delivering first-class public services in Hampshire and throughout England. Because we are managing the economy better, we can afford record investment in public services. In 2000–01, we invested an extra
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£21 million in national health service ambulance services in England to help them to continue making progress by investing in extra vehicles and front-line staff. That funding has been made available on a recurrent basis and is being backed up with significant local investment. In Hampshire, that included £450,000 last year. A further £1.2 million is expected this financial year—an extra £1.7 million in total.
However, improving ambulance services is not just about more ambulances on the road; it is also about planning and partnership. The right hon. Member for North-West Hampshire (Sir G. Young) made a point about where vehicles are located. The hon. Member for Isle of Wight (Dr. Brand) referred to ambulances being told to wait in car parks, which are not proper conditions in which to work. In fact, we are talking about a sophisticated process of anticipating where accidents will happen Ambulances do not always return to the same base. In some areas, for example, they may share facilities with the fire services. In my area, ambulances make what they would call pit stops, for cups of tea and so on, at their stations. All the services are working together, and the best way of using vehicles in the most appropriate places is kept under review. That is the partnership to which I referred.
With Hampshire ambulance service, we have seen co-operation and collaboration on many initiatives that have benefited patients and helped the ambulance service. Further investment has been made. We have invested £3.5 million in modernising the accident and emergency department at Southampton general hospital.
The hon. Member for Gosport (Mr. Viggers) referred to Haslar hospital. The reconfiguration process has not always been entirely happy, but the current arrangements mean that the services at the accident treatment centre will be continued. There is no particular timetable for Haslar's closure; we have said that it will coincide with the opening of the new private finance initiative hospital in Cosham. I hope that the hon. Gentleman is reassured that his constituents will continue to be served.
As for the review that many hon. Friends have mentioned, a formal period of statutory consultation will shortly commence. No decision has been taken; there is no fixed plan, as some hon. Members have suggested. We hope that implementation will be possible by 2002.
Our driving motivation is a better ambulance service, which serves the populations of all areas in the interests of patients, and responds to the changing needs of patients and to the reconfiguration of the NHS.

Digital Television
11 am
Dr. George Turner: I am delighted to introduce a debate on the future of digital television. Events are moving fast, in terms of both technology and commerce, and important concerns have been raised in the report of the Select Committee on Culture, Media and Sport, published last month, and the recent survey conducted by the Consumers Association. The latter has attracted much media attention because of the doubts that it raised about the practicability of the Government's timetable for the switch-off of the analogue signal. As the Minister knows, I have a strong constituency interest in the future of digital television because large numbers of my constituents in west Norfolk have long suffered from reception problems with analogue television. Regrettably, when the previous Government legislated for the introduction of digital television, they dismally failed to take account of the problems experienced by my constituents—and, as previous Adjournment debates have shown, those of hon. Members representing many parts of the country. Some 40 or 50 hon. Members have constituents with cause for complaint.
Since entering the House, I have been working to ensure that when the Government legislate—early in the next Parliament, I hope—my constituents' problems will be addressed. I shall briefly remind the House of the nature of those problems. The services of each regional television broadcaster are transmitted from specific locations, but in some areas the lie of the land and the physical characteristics of UHF electromagnetic waves prevent communities from receiving signals from transmitters assigned to their appropriate regional broadcaster; they may be able to receive only the signal from a transmitter targeted at a different region. Those viewers can watch only regional programming services intended for others. That is the nub of the problem. Many of my Norfolk constituents receive regional programmes that are in broad measure intended for Yorkshire and the north of England.
For many years, solutions using additional transmitters or relays have been considered, but constrained by the possible number of channels when using analogue broadcasting, which is greedy in its use of frequency space, and by the severe interference problems that arise when adjacent transmitters are not well separated in frequency. It is a particular problem in my part of the country because of the adjacency of European transmitters across the sea. That is why analogue broadcasting has genuine difficulty in providing more than four universal channels: not surprisingly, many of my constituents cannot properly receive Channel 5.
Many thousands of homes in west Norfolk are affected. The borough council estimated the figure to be as high as 20,000, which represents an audience of up to 51,000 in my constituency alone—and they want something to be done. As I hope hon. Members will understand, they want to watch their own regional television programmes. They are not alone in giving high priority to regional broadcasting. Surveys repeatedly show that 90 per cent. of the British public want regional news, which has more support than any
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other kind of programme—30 per cent. more than for soap operas. The programmes that many viewers most want to watch are the very ones denied them—and my constituents in particular—by the anomaly in broadcasting.
Issues of community and regional identity are increasingly important, especially since the Government came to office. My constituents are served by health authorities, social services, education services, library services, police services and fire services, all of which are administered on a county basis within Norfolk. Through the establishment of regional development agencies, the Government have made it clear that local and regional identity is increasingly important. Ministers are encouraging communities to become involved in community safety and local transport strategies, and see a strong role for the community in developing policies on access to the countryside.
Mr. Simon Thomas: On the point of regional identities in England and national identities in Wales and Scotland, the National Assembly for Wales does all the work that the hon. Gentleman referred to on a regional and national dimension, and more. However, does he share my concern that 10 per cent. of analogue receivers in Wales do not get any Welsh signals, which means that 10 per cent. of the Welsh population do not know what the National Assembly is doing in their name?
Dr. Turner: I certainly sympathise with the hon. Gentleman, and I well understand why he is among those who have been pushing for a solution.
Let me return to the importance of regional identity. My comments illustrate a growing and serious democratic deficit—which the hon. Member for Ceredigion (Mr. Thomas) referred to nationally and I see regionally—if people cannot have access to news and information about their own communities via the most popular and effective medium, which is television. Like the majority of viewers throughout the country, my constituents want to know what is going on under their noses and in their communities. Access to television is much more important than might be suggested by its entertainment content. In today's society, access to information is central to quality of life; television is a key provider of that information and will become even more important in the digital era. Technical solutions to our problems exist in the digital era, but there must be the political will to ensure that they are exploited. That is why, on behalf of my constituents, I want to see continued scrutiny of the process of change.
As the Select Committee on Culture, Media and Sport acknowledged, the success of commercial pay television in the UK since launch has been striking. BSKYB has been so successful in converting analogue subscribers to digital that it expects to switch off its analogue signal later this year, when it will provide digital services to about 5.5 million homes, which is some 20 per cent. of households. ONdigital has built up a new subscriber base from scratch and recently announced that it has more than a million subscribers, which is also roughly the current level of uptake of digital cable television.
Given that fast uptake, one might ask what the problem is. Put simply, the problem is that not everyone will want, or be able to afford, pay television. The

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Consumers Association survey found that 32 per cent. of people who do not have digital television say that they will never get it. Perhaps more importantly, almost half those surveyed said that they would only want to watch free-to-air channels after analogue switch-off. The latter figure is close to the estimate of 40 per cent. made by the British Radio and Electronic Equipment Manufacturers' Association. Even if we take the BREMA figures—the lower of the two—some 9 million homes will need access to either proper digital sets, which are normally referred to as integrated digital televisions, or appropriate converters by 2006–10 if the Government are to stick to their schedule for analogue turn-off. The scale of the problem is apparent. Some 4 or 5 million sets are sold annually, but only 90,000 were digital televisions last year, despite the fact that analogue televisions will become useless in a few years. Projections for this year say that only 180,000 digital television sets, which have a long and guaranteed lifetime, will be sold.
Mr. John Greenway: The hon. Gentleman is making important points. Does he agree that many advertisements for new televisions are grossly misleading in that they refer to digital television sets but are selling sets that are incapable of receiving a digital television service?
Dr. Turner: I accept that. The Government have started to address the problem of confusion in the marketplace, but need to do more.
With an uptake of 180,000 this year, the figures provide little support for the view that, without further intervention, total sales will be anywhere near 9 million by 2010, let alone 2006. Something must be done. The consumer has clearly found the marketplace unnecessarily confusing.
The chosen marketing tool for digital television has been the provision of free set-top boxes. The service provider suffers a significant initial loss, which it hopes to set off over time by income from subscriptions. That is why the providers are targeting better-off households. A side effect of this market-led process has been that many analogue sets, supported by a continued price differential, are still being sold without the consumer realising that they have a limited lifetime.
I am pleased to note the Government's prompt response to criticism of labelling and the introduction of kite marking so that potential purchasers of non-digital television sets are clearly warned about the potential limited life expectancy. I am also pleased to note that the Government are trialling free provision of digital access in a limited number of areas. I hope that the Minister will tell us more about that, particularly the period of the trials and when we are likely to hear the results.
I agree with ONdigital's proposal, which would require changes to European law to ensure that a date is set for the mandatory inclusion of digital receivers in new television sets. The resulting increase in the production of digital televisions would result in significant economies of scale and a marked reduction of the current high prices.
There is a clear role for the Government. They must ensure that all citizens, not just the wealthy, can share the potential benefits offered by digital television.
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Disadvantaged groups must not be left behind and we must acknowledge that a significant minority will be unable to afford the premiums for pay TV. The Government's commitment to availability and affordability criteria and the conditions for analogue switch off must remain central to policy development.
I was pleased that the White Paper so clearly acknowledged the specific problems of my constituents. Along with others around the country, some are denied access to regional programming. I hope that my hon. Friend the Minister can report progress on the consultation process promised by the White Paper. She knows that I am keen to be involved in finding solutions and she is aware of my impatience to do so.
Last year, the Minister visited my constituency and she will recall her visit to Hunstanton and Heacham. On Saturday I was visiting homes close to the sensory garden that she visited on that occasion. She will understand the frustration of my constituent who complained that his family subscribed to ONdigital so that digital terrestrial broadcasts with many more channels were available, yet was still unable even by payment to watch local news and other regional programmes. The same is true for satellite television. We must press for early resolution of that problem.
The introduction of digital television is made immensely more complicated by the need to maintain analogue broadcasts with all the problems of interference that arise. Transmissions are limited by the availability of frequency and by power, which leads to the frustration of subscribers. I fear that the result of consultation on removing the anomalies in my locality will reveal a dependence on analogue turn-off. Only then will the digital era truly have arrived.
In light of the facts highlighted by the Consumers Association, the Government will have to do more than provide a legislative backdrop. It is in the national interest to exploit the opportunities of the digital revolution and a Government who acknowledge the need for encouragement of the entrepreneurial spirit of our nation must themselves be willing to encourage and adopt radical solutions to public interest problems.
The National Consumer Council has stressed the complexity of the marketplace for digital television. It argues for clear and accurate information about the differences between analogue and digital and the advantages and disadvantages of different platforms and packages. I strongly support its argument for a high profile, Government-led public information campaign on digital switchover. If people are to continue to buy analogue televisions with a limited lifetime, they must do so knowingly, not because the salesman found it the best sale to make. There is much evidence that digital is often equated with pay television and that is an unattractive proposition for many. The content and services offered by free-to-air public service broadcasters will be of critical importance in increasing digital take-up and making digital broadcasting popular with a wider section of the population.
We must ensure that there is a proper framework for the delivery of public service broadcasting. A large proportion of those who will, at best, be reluctant to transfer to digital television will be pensioners. I have 23,000 of them in my constituency and I am well aware of that fact. The Government should do more to

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encourage and help them to benefit from the improved services of the digital era. I urge the Government to extend the free television licences available to those of 75 and over to households with elderly people of 65 and over. That extension could be a financial incentive making digital television affordable. It would also address the many anomalies in licence requirements for that age group.
I was disappointed that the Stewart commission failed dismally to resolve a situation where, depending on the nature of accommodation and with no regard to the ability to pay, some pensioners receive free television licences and others do not. I can assure the Minister that an extension of free television licensing would be immensely popular. In a brief period before the Budget I attracted 3,000 signatures to a petition calling for free television licences for people over 65.
Given that the nation stands to benefit financially from the analogue turn-off, further Government measures to encourage the take-up of digital television should at least be considered. Some in the industry believe that it might be appropriate to consider the use of a preferential rate of VAT. Even a limited period of reduction would help to kick start the volume of sales which will themselves reduce prices and address the issue of affordability that the Government have identified as central to the problem.
As I have explained, my constituents have a particular interest in seeing fast progress in the full introduction of digital television. The Minister has shown considerable sympathy for the problems of my constituents and has been generous with her time in discussing them with me. I hope that she can do more today and promise solutions and a timetable. I hope that she will confirm the Government's commitment to legislation, if necessary, to ensure a proper balance between commercial interests and public good in broadcasting. I hope too that she will acknowledge the need to take further action if we are to meet the Government's timetable for analogue turn-off. I strongly commend the help that I have suggested for the elderly to ensure that they too benefit from the early introduction of the digital era.
11.18 am
Mr. Simon Thomas: First, I thank the hon. Member for North-West Norfolk (Dr. Turner) for initiating this useful debate which is certainly of great interest to many of my constituents and many people in Wales. Access to analogue signals in the past has been a problem in Wales in that up to 40 per cent. of the Welsh population receive signals from the regional stations in England rather than from those in Wales. As I said when the hon. Gentleman kindly allowed me to intervene, 10 per cent. of the Welsh population find it difficult to receive any Welsh signals. That means that they are deprived not only of Welsh language broadcasting, but of information relating to the growth of systems of government such as the National Assembly for Wales.
North-east Wales and the area that you represent, Mr. Deputy Speaker, is one of the areas that traditionally have difficulty in accessing the full range of services. The hon. Member for North-West Norfolk was correct to say that digital television provides the opportunity to get rid of that discrimination and to give
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people in all areas access to the full range of entertainment, information and other useful services that will come on stream.
Mrs. Jackie Lawrence: I endorse the hon. Gentleman's comments completely, but would he not also agree that in areas such as my constituency digital television will also enable those who are monoglot English to gain access for the first time to channels such as Channel 4? While he stresses the fact that it will give Welsh speakers access to Welsh language programmes, it will also mean that monoglot English will have access to their choice of channels.
Mr. Thomas: That is true for everyone in the United Kingdom. It is now possible to have access to Welsh-language television here in London, which I welcome, as no doubt the hon. Lady's constituents will welcome access to Channel 4 in Pembrokeshire. We are debating the effects of digital television, and one thing that will disappear in the near future is the idea of an entire community watching the same television programme at the same time. That will end, as television, radio and the internet all merge into digital information, which we will choose to use, download or watch in whichever way we see fit. The hon. Lady's constituents will make their choices, and my constituents will make theirs. However, I am concerned that we should protect Welsh language needs and I will address that shortly. Obviously, the world is dominated by English language broadcasting—if that is the right term for what happens on the web—particularly in digital transmission.
I want to concentrate my remarks on two aspects of the future of television digitalisation: diversity and access. We in Wales attach a particular emphasis and importance to what would pass for regional television in the remarks of the hon. Member for North-West Norfolk. It is important to note that, in Wales, regional television is our national television. Our national broadcasting depends on the regional arms of either Carlton Communications through HTV or the BBC, or our one national station, which is S4C—Sianel Pedwar Cymru. However, S4C is also diversifying into digitalisation and taking up the opportunities that lie beyond the boundaries of Wales.
A difficulty that arises is the manner in which regional television sometimes plays out in national terms. I will give two examples. The first is, perhaps, a rather light-hearted one: Anne Robinson's recent comments about the Welsh were not well received in Wales. Many of us treated them with the respect that they deserved. Somebody who wants publicity so that she can enhance her manor house in Gloucestershire is welcome to any publicity she can get. However, people in Wales did not want to see a repeat of that programme. They would have preferred something that was a bit more positive about Wales, or a different "Room 101" programme, but that was not possible. The repeat programme was broadcast nationally throughout the UK. So, through regionalisation, we get a rather warped perception of our national concerns.
The second and more important example concerns news broadcasts in Wales. Although the moves by the BBC to integrate—I would say tag on—Welsh news into the main news are welcome, we must wait for 27 or 28 minutes before we get the news from Wales in the

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broadcast at 9 o'clock in the evening. That might not seem so important, and it might be that news from elsewhere in the world, particularly from London, is more important. However, in the present foot and mouth outbreak, we are missing an opportunity to transmit a clear message about the situation in Wales with respect to tourism and access to the countryside. Such information is broadcast at the end of other stories that are not as pertinent to the Welsh situation. That skews perception and is one issue that we should examine as we move to digitalisation. We should change the arrangement so that we have a different feed in the Welsh context. As the hon. Member for Preseli Pembrokeshire (Mrs. Lawrence) said earlier, people would have more choice of news programmes under digitalisation.
Mr. Norman Baker: My constituents wait for 28 minutes to hear news about East Sussex, but then get traffic reports about Dorset on the local news
Mr. Thomas: I am sure that the hon. Gentleman's constituents find that very useful. A similar situation exists in parts of Wales along the Severn estuary, where people get news about Bristol before they get news about Cardiff and Swansea.
I emphasise the importance of S4C in terms of diversity—not just for Wales but the UK. Valuable initiatives have been undertaken by the Minister's Department, with the cultural diversity network trying to demonstrate cultural diversity on all platforms of television. As I hope she already knows, S4C is the jewel in the crown of cultural diversity in the UK and Europe. It was difficult to establish S4C, but it has been an undoubted success. It has proved value for money and has shown how Welsh language broadcasting can compete with English language broadcasting; it is just as entertaining, informative and valuable to its own constituency.
Importantly, S4C has also fed a cultural revival in Wales. We have had the metamorphosis of Welsh language bands such as Catatonia and Ffa Coffi Bawb—which became Super Furry Animals—which have become international successes and a Welsh language film, "Hedd Wyn", being nominated for an Oscar. Such success could not have happened without S4C or while Welsh language programming was scattered over various channels. That concentration of resources has been of huge benefit in Wales. Bands such as Catatonia may be rock bands, but they have shown how Welsh language influences come over into English and influence Wales through that medium. We also have the opportunity to create an English language S4C, if that is the right term—a channel devoted to English speakers in Wales that views Wales and the world from their perspective. The BBC has taken up that challenge and is considering BBC2 Choice in Wales to fulfil that role. We need to consider how we can protect it.
Resources are a problem. S4C gets £48 million a year, which I am sure is generous, but Channel 4 gets £650 million a year. One of the problems for S4C is that it cannot buy programmes from sources other than the BBC, HTV and independent producers in Wales, although it makes an increasing number of back-to
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back productions with Russia and other European countries. Many hon. Members will have seen over Easter the animated tales of biblical stories that S4C produced in association with other European countries. S4C is therefore an international player, but it cannot simply buy "Friends" or "Frasier" from American channels because they are not in Welsh. Dubbing programmes into Welsh was done to death when we tried to dub "Shane". That experiment has gone down in Welsh history and will never be tried again. Welsh language programming, and the diversity that exists, need to be protected, as I shall explain later.
On the important issue of access, mentioned by the hon. Member for North-West Norfolk in opening the debate, the Government have made it clear that the switch from analogue to digital will not take place until around 95 per cent. of all subscribers or consumers have access to digital. That 95 per cent. should not be just a UK figure. There should be a way of disaggregating it down to Wales and Scotland and possibly also to regions of England. If anyone in west Wales—in Ceredigion, for example—wants to buy a mobile phone, he or she may go to a mobile phone service that covers 97 or 98 per cent. of the population. However, the 2 or 3 per cent. of Britain that is not covered comprises west Wales and the highlands and islands of Scotland. It will be difficult to justify a complete switchover to digital in Wales until we can show that the Government's 95 per cent. target is also being met in Wales and that we are not disenfranchising Wales and repeating the mistakes that we have made with analogue. However, the situation is encouraging in that take-up of digital in Wales is higher than in England. I have asked questions on the issue, but official figures are not available; my information is that take-up in Wales is somewhat higher than in England. I am not sure why that should be but it is welcome for the future.
Take-up is mainly of satellite. We have three main digital platforms: terrestrial, cable and satellite. However, most people in Wales cannot access either cable or terrestrial digital platforms. Terrestrial digital take-up in Wales is very poor, as is access to Channel 5, which the hon. Member for North-West Norfolk mentioned. Cable is available in Cardiff, its environs and some other parts of south Wales, but not in north Wales and certainly not in mid-Wales, which includes my constituency. We therefore need to consider how we can have access not only to digital as such, but to the full range of digital platforms, because there will be differences among what is offered by cable, satellite and terrestrial platforms
Dr. George Turner: Would the hon. Gentleman say that, for his constituents—and mine—free-to-air broadcasts, which can be received in any room in the house if they have a normal household aerial, are the most desirable platform?
Mr. Thomas: Indeed. That is the most desirable platform as it would not force people to pay for digital. It is vital that we support public service broadcasting. The Government need to recognise that digital is not yet available throughout Wales, and terrestrial digital access will not be at 95 per cent. when the switchover takes place. It is simply not good enough to say that people have access to satellite. Whichever way we

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consider it, we are paying for satellite. The boxes may be free upfront, but the pressure to subscribe is enormous. As the hon. Gentleman said, that is the only way in which the companies can get their money back. Free-to-air terrestrial broadcasting is also the only way in which an English language channel for Wales will be created.
Let my conclude by explaining how we can achieve our objectives in Wales or at least try to protect access and diversity. We need to address questions, not difficulties, about diversity as we work though the rollout of digital broadcasting. The White Paper suggests that we have a new office of communications—an Ofcom. I suggest to the Minister that serious thought is given to the establishment of an Ofcom for Wales. The National Assembly for Wales has said that it would like to have a Wales office of Ofcom and that it would like to appoint the Wales member of Ofcom. However, questions of accountability are raised if one body appoints to another body, which is in turn answerable to another body. My preference and that of my party is to consider an office of communications for Wales that can integrate radio, television and the increasing amount of digital broadcasting that will take place and consider them from the Welsh perspective.
The experience of the BBC Wales governor, sterling though his work is as an individual, calls into question whether we could have in one person sufficient protection of Welsh interests. At the very minimum, we certainly need a Welsh consumer panel in Wales. It would not be acceptable to establish a consumer panel for the UK and simply have a Welsh office of it. We need a Wales consumer panel that is based completely in Wales and considers Welsh consumer needs. Welsh language broadcasting is a unique feature of Wales and needs to be embedded in the future.
We have seen the importance of communications in the cultural life of Wales and the need to protect them. The Welsh language would not be alive today if the Bible had not been translated into Welsh when it was the most important method of communication. That is why the Welsh language is alive, but the Cornish language is not. The most important method of communication was translated into Welsh at the right time, when literacy was growing and people could use it to maintain a sense of Welsh identity through the Welsh language.
That is no longer the case. Wales is not a monoglot Welsh-speaking country; we are a bilingual country. To maintain Welsh culture during globalisation, which involves the break-up of Welsh-speaking communities, people in Wales must have access to Welsh and English language programming that gives them experience, entertainment and information from their own communities. That is provided in the main, but with some difficulty on occasion. Government decisions on the future of digital television and particularly access to it will determine whether we can ensure that we have a thriving Welsh language and English-speaking communities in Wales in the future. I hope that the Minister will act accordingly.
1.34 am
Mrs. Linda Gilroy: I congratulate my hon. Friend the Member for North-West Norfolk (Dr. Turner) on securing such an important and timely debate.
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I should also declare an interest, which is not pecuniary, but a constituency interest. My constituency contains ONdigital's main customer service centre, which employs about 1,400 people. My hon. Friend the Member for Preseli Pembrokeshire (Mrs. Lawrence) has an equally important ONdigital customer service centre in her constituency. Both my hon. Friend the Member for Plymouth, Devonport (Mr. Jamieson) and I were keen to have in our city a company that we believed would be at the cutting edge of 21st century communications, and we worked hard to encourage it to come to Plymouth when it was looking for a suitable base for its customer service centre.
Neither the company nor we have been disappointed, and ONdigital has found that Plymouth is a good place to do business. As my hon. Friend the Minister knows from several recent visits, it is a beautiful city with a pool of people who can make an excellent and talented work force and have skills that are adaptable to the high-class customer service that is expected of a company such as ONdigital. The company's expectations have been met, because that work force has been able to attract 1 million customers in two years, which the company set itself as a target, and has made an important contribution to the rollout of digital television services. The company is confident that it will attract 2 million customers within four years, which is its next target.
As constituency Members, we feel that ONdigital has brought something valuable to Plymouth. It is a key player in my constituency and in our city, and has helped us to achieve one of the biggest drops in unemployment in the country. I have visited ONdigital many times and, with my right hon. Friend the Secretary of State, have found it to be a modern, enjoyable and interesting place to work; many constituents who work there confirm that. The general manager, Alan Lawson, not only provides leadership to the customer service base that ONdigital operates, but plays an active role in the call centre forum, which was set up to promote high standards in call centres in Plymouth and to identify common interests. Through that constituency interest, my interest in the future of digital services, including the television services that are the subject of today's debate, has developed.
Of course, the Government want to encourage all platforms, including satellite and cable, but, of the three, terrestrial will have the key role in winning the hearts and minds of those who are yet to commit themselves to digital television services. Those services must be available, affordable and attractive. Digital terrestrial will be the way in which most UK homes ultimately find both availability and affordability. Almost all homes—but not all, as we heard from the hon. Member for Ceredigion (Mr. Thomas)—have an aerial through which the services can be delivered, whereas cable passes by about 50 per cent. of homes, and there are severe cost-effectiveness constraints on rolling out cable to as many homes as aerials can serve.
Availability and affordability are closely linked with the service provided through satellite. The hon. Gentleman referred to predominantly premium pay services that have a target income per consumer of £300 to £400 per annum to sustain the service. In constituencies such as mine, where I inherited from my Conservative predecessor the poorest ward in England, that is an insurmountable barrier for many people.

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Some might say that if it is attractive, people will pay for it. However, we are sadly some years—perhaps even a couple of decades—away from people across the country having incomes that can sustain that level of payment for television packages.
There are two barriers to the attractiveness of digital television. My hon. Friend the Member for North-West Norfolk has referred to the confusion about the benefits of digital television. There is also confusion about what equipment can receive digital signals. The question of whether the market is operating in a sufficiently robust and competitive way to allow it to deliver attractive programme packages at affordable prices is another issue. That, as hon. Members will know, is the subject of a Competition Commission inquiry. It is probably appropriate to mention that in passing today, but not to go into the issues that are being examined by the commission. However, those issues are very important to the future availability and—crucially—to the affordability of the pay TV sector.
If rumours in the press over the weekend, in The Sunday Times and in the Financial Times on Monday are correct, there could be an interesting development this week among some of the key players in television and digital services, which might have a significant impact on the market and its ability to operate in a competitive manner.
On customer confusion over equipment, a number of hon. Members have spoken about the difficulties of finding digital televisions. At Christmas—a popular time for buying televisions—if one went into an outlet of one of the major retailers, it was quite common to find 200 televisions on sale, of which only five were digital televisions truly capable of accepting digital signals.
Some hon. Members have campaigned on that issue. I am pleased to say that there is an early-day motion before Parliament congratulating my hon. Friend the Minister for Small Business and E-Commerce. Her Department, working with the digital video broadcasting consortium, has developed a logo that will be visible on the screen of all digital televisions as well as boxed digital televisions. Hopefully that will give an impetus to sales, helping to create the volume of sales required for cost savings to be made so that digital televisions can become more affordable.
Beyond resolving that particular source of confusion, there is a further need to raise awareness among the 70 per cent. of British adults who do not yet have digital television. They need to know that, in buying a DVB-labelled TV, they get free access to a wider range of channels, including BBC Choice, BBC Knowledge, BBC News 24 and ITV 2. According to the recent Consumers Association report, "Turn on, Tune in, Switched off", which has already been mentioned, only 29 per cent. of respondents to the survey conducted by the association knew that the five existing terrestrial channels would not cost extra after analogue switch-off, let alone that there are new free channels available on digital. As my hon. Friend the Member for North-West Norfolk said, digital television is wrongly associated with pay television, and if we are going to get sufficient numbers of people to switch over to digital initially, we must crack that myth.
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The Consumers Association report identifies a range of challenges that need to be overcome. There is a great deal of confusion. The expense of digital television is a key barrier to take-up. That report identifies many, particularly among the young, those with children and those in lower social grades, who say that they do not need or would not the use extra channels. Just under half of people who have not thus far switched are aware that the Government plan to switch off the analogue signal in the next five to l0 years.
A lot more needs to be done. The challenges that have been identified require a concerted effort to raise awareness, to advocate the benefits of digital television and to bring about action. The DVB consortium was set up in 1993 and I am sure that it will play a role in that process. It is an industry-led consortium of more than 290 broadcasters, manufacturers, network operators, software developers and regulatory bodies that are committed to designing global standards for providing digital television and data services. I do not think that the consortium alone will be able to achieve the required level of awareness, advocacy and action. It played an important part, together with the Department of Trade and Industry, in launching the logo. That is effectively a kite mark, reassuring people that when they pay, at present prices, more than£1,000—sometimes as much as£2.000—on a television, it will at least do what they expect.
A bigger and wider job remains to be done, which calls for a digital services and communications champion. I hope that the Minister will confirm that the Government intend to institute something of that kind this year, because if we are to achieve analogue switch-off in the time scale that the Government hope for, we need someone to help to develop the appropriate awareness and see that digital services are advocated inside and outside Government. A clear, consistent message is needed to bring about not just action, but joined-up action, across the plethora of meetings and players involved, which include the Independent Television Commission, the Department of Trade and Industry, the Department for Culture. Media and Sport and the broadcasters. All have an interest in driving matters forward. Many meetings are being held and huge energy and commitment are being expended on the task. Nevertheless, the Government should soon appoint one person to focus that effort on bringing digital services in the required time to as many people as possible. I look forward to the Minister's observations on that question.
I congratulate my hon. Friend the Member for North-West Norfolk on initiating this important debate, which has been a helpful opportunity to discuss the challenges ahead. My constituents have an important contribution to make. They and the House can count on my interest in and commitment to work on the policy and legislation that will help to develop digital provision.
11.48 pm
Mr. Norman Baker: I congratulate the hon. Member for North West Norfolk (Dr. Turner) on initiating the debate. I agree with all his points, as well as those made subsequently. The technology is far reaching, but does not give rise to political differences. That probably makes it a bad story for the media.

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Digital technology will make a big difference to our communities. I have identified three key differences: the freeing of spectrum to make space available for extra channels and services; the fact that digital signals are of better quality than the analogue signals that have been around since the 1930s; and the fact that digital signal uses spectrum more efficiently, which means that, at least in theory, it is possible to achieve a better and wider range of services and to deal with the issues that the hon. Gentleman raised about regional coverage.
I think that the hon. Gentleman receives Yorkshire television in Norfolk and I touched briefly on a similar problem in an intervention. Part of my constituency receives a signal from the Isle of Wight, which means that we receive lots of interesting local news about Hampshire and Dorset and not very much news about Sussex. That difficulty needs to be rectified. For many people, that is the great bonus of digital television.
Of course, there are not only problems relating to regionalisation. Channel 5 has already been referred to. My constituents and others who live along the south coast cannot receive Channel 5 because of conflicting signals from French television. We cannot even receive French television, but we can receive a series of wavy lines, which, I am told, are not as good as Channel 5 on a good day. I have received a few letters from constituents who want a 20 per cent. reduction in their licence fees on that basis. I have not put their point to the Minister or to the BBC, but I have told them that their plea is unlikely to be successful.
Like the hon. Member for Ceredigion (Mr. Thomas), other areas of my constituency, such as the village of Kingston, have difficulty receiving normal signals. We must use the digital revolution to improve regional coverage. The capacity exists, but it must be seen in conjunction with what has happened to regionalism generally. There are conflicting dot developments. There is a move towards regionalism in this country, which I welcome, with greater powers for the Welsh Assembly and Scottish Parliament—and, in time, no doubt, for the English regions. That is underpinned by the trend in the European Union towards recognising regions. However, at the same time, regional identity is being eroded. The sort of houses that were distinctive in a certain area are being replaced by Barratt Homes, so that an estate in Ceredigion looks very much like an estate anywhere else, which is unfortunate. A shopping mall in Burnley is not only the same as one in Glasgow, but is probably the same as one in Ohio, with a traditional Tesco toytown clock, like the one in Lewes.
We need to protect and enhance our regional identities, and this technology gives us a way of doing that. However, it is important that technological developments should be mirrored by a political determination to ensure that regional television is protected and enhanced. We are moving towards one ITV, but ITV has been the traditional deliverer of regional services—more so than the BBC. If one lives in Tyne Tees, Yorkshire or the Meridian area, one tends to look to the ITV network more than to the BBC for local news, although that is not the case everywhere. It would be an irony if we did not use the regional capability of digital technology and were instead to retrench towards a national ITV. The Government must make it clear that ITV cannot be allowed to reduce its regional
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coverage, because that is its main public service element, or its regional production facilities. We do not want everything to come from London.
I have mentioned the potential benefits, as well as some of the problems, of digital television. I understand that the Government are moving towards the introduction of digital neighbourhood schemes, whereby local neighbourhoods will receive digital television free of charge as a way of raising awareness and monitoring people's reactions to the technology. Perhaps the Minister will say something about that in her reply. However, if the Minister is looking for areas of the country to take part in that scheme, I offer her Lewes or any part of my constituency.
No one has mentioned digital radio in any detail, and it is important not to overlook it—[Interruption.] I apologise—the hon. Member for Preseli Pembrokeshire (Mrs. Lawrence) did mention it, but I want to develop the point. It is important for the Government to set targets for digital radio, as they have done for digital television, so that we know when digital radio will kick in. I accept that there may be a longer time frame, and that it might not be as easy. Nevertheless, those for whom radio is their preferred medium, as well as those who prefer to watch television, are entitled to attention. The cost of digital radios is rather high. That needs to be addressed, not simply by the market but, ideally, by Government action to stimulate that market.
Hon. Members have referred to the problem of labelling. I am pleased about the useful initiative that the Minister for Small Business and E-Commerce has taken. One of the biggest inhibitors of digital take-up is the uncertainty that exists around the technology. If people could be confident that the digital set was the norm in the shops—so that they did not need worry about it, knowing that it would serve their needs in the years ahead and that it was ready for the technology—they would buy it and take more interest in the matter. If they have to fiddle around and work out what is what, then worry about where it works and what it does, what digital means and whether the sound quality or the signal is an issue, they will say "I cannot be bothered with this" and will wait until it has developed further.
The Government have a major role to play in getting things right. This change is more complicated than previous ones. People in the industry compare it to the change from 405 to 625, or that from black and white to colour, and say that consumers coped. It is not the same. The concepts were simple to master; this is complicated for those who are interested not in the theory, but in the end result. It is up to the Government to make it easy for them to get digital access and to be confident that what they are buying is what they want to buy.
The Government's targets for digital take-up are, by and large, right—99.4 per cent. of households being able to receive a digital signal, 95 per cent. of households signing up to digital television and digital television being affordable. However, I agree with the hon. Member for Ceredigion about the importance of a regional perspective. We have to ensure that those are the percentages in the area in which the consumer lives, rather than national figures that do not apply to him. There is a degree of unanimity across parties and in the country at large. That is healthy. Digital technology can undoubtedly bring many benefits to our communities. It is up to the Government to remove the obstacles that

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have been identified by me and by other hon. Members in order to ensure that those benefits are freely available, and that their provision is supported.
11.57 am
Mrs. Jackie Lawrence:I, too, congratulate my hon. Friend the Member for North-West Norfolk (Dr. Turner) on securing the debate. It is pleasant and unusual to have a debate in which everybody agrees on the objectives and wants to work towards achieving them as quickly as possible. As my hon. Friend the Member for Plymouth, Sutton (Mrs. Gilroy) mentioned, I also have a constituency interest in the issue. ONdigital, one of the terrestrial suppliers of digital television, is a major employer in my constituency, so it is important to Pembrokeshire. It represents a growing industry, which has provided 800 jobs in the last 18 months and is set to provide 1,100 by the middle of summer, bringing further benefits to my constituency, which has always had high unemployment.
I am a convert to digital television. Anyone who has watched both digital and analogue broadcasts will know that the difference in sound and picture quality is incredible. There is no comparison. The hon. Member for Ceredigion (Mr. Thomas) mentioned choice, and that is another major benefit offered by digital television. A spin-off, of which the broadcasters are aware, is that as the choice increases the onus will be on them to provide ever better quality programmes, because, in the long-term, that will be the only way in which they can secure viewers who have that increased level of choice.
Another element, which I do not think has been mentioned today, is that digital television could contribute significantly to the Government meeting their commitment to get everyone in Britain on-line by 2005, giving people who are not familiar with PCs or other computers access through their television set. That would be very valuable. The main work provided by ONdigital in my constituency is customer service support for ONnet. That is a growing sector and an industry that I hope will be of increasing benefit to my constituents.
The hon. Member for Lewes (Mr. Baker) spoke of uncertainty in the public mind. There is more than uncertainty; there is confusion. The problem is that most of the public do not understand the difference between analogue and digital. For example, they do not know that there are three ways in which they can receive digital television—via satellite, cable or terrestrial networks.
It is important to reaffirm the need to ensure that, as digital television signals come in, the current 70 per cent. rate of coverage will be increased dramatically so that everyone is covered, wherever they live. In Wales, we have our own specific problems. Unlike the rest of Wales, the terrain of my constituency is characterised by dips rather than hills. However, it is just as difficult to receive signals in coastal valleys as it is in hilly areas. It is a massive job to ensure that when digital television expands it covers all areas of the UK.
There is also a major problem with shared aerials, which I do not think has been mentioned this morning. In the UK, 6 million homes have shared aerials, and if
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we want terrestrial digital television to expand, that is important, because many of those homes are owned by councils or housing associations. The Government have a major role to play in encouraging and supporting local authorities and housing associations in providing the facilities to enable those homes to receive digital television.
We must tackle public confusion on the matter. Many people transfer to digital because of an interest in sport. Consequently, digital television has the reputation of being a pay television service. People do not always understand that they can receive the service in a different way, without having to pay great sums of money.
There are three ways in which the Government can help, some of which have already been mentioned. First, there should be a Government-led, not an industry-led, information campaign. That is very important. My hon. Friend the Member for Sutton touched on a Office of Fair Trading inquiry. The necessity for that inquiry is testament to the involvement of vested interests and to the fact that the drive to provide people with information about the benefits of digital television needs to be independent and Government-led.
Secondly, the Government should appoint a digital champion with responsibility for driving forward the take-up of digital television and ensuring that people are informed. Finally, considerable effort should be made to ensure that all televisions sold after 2004 contain a digital receiver. Presumably, that would be done through European legislation. Such a measure would go a long way to ending the confusion and protecting the consumer.
12.3 pm
Mr. John Greenway: I also congratulate the hon. Member for North-West Norfolk (Dr. Turner) on securing this debate. During his time in the House he has frequently raised the problems of the regional dimension of television broadcasting and how it affects his constituents. I remind hon. Members of my long service as a consultant with ITV and prior to that with Yorkshire Television. I know only too well what a headache the issue raised by the hon. Gentleman was for Yorkshire Television. Digital television undoubtedly provides a great opportunity to correct the problems that this country's analogue signal arrangements have presented for many viewers.
The debate is timely, not just because of the news coverage about the potential restructuring of ONdigital—I was interested in what the hon. Members for Plymouth, Sutton (Mrs. Gilroy) and for Preseli Pembrokeshire (Mrs. Lawrence) said about the importance of ONdigital in their constituencies—but also because of the Select Committee report and the comments of the Consumers Association on digital uptake. The starting point for our consideration of this matter must be that it remains in Britain's grasp to become the first country to achieve an orderly roll-out of digital television. That was the previous Government's objective as well as being the present Government's and it largely drives the consensus that exists between the parties on many relevant issues.
As the hon. Members for Sutton and for Preseli Pembrokeshire have shown, there are huge benefits to be gained from technology manufacturing jobs, the

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manufacturing of television and associated equipment, and the potential export markets. If we become the first country to do what is necessary, that opportunity will open up. None of us need doubt that the project is worth while.
Some worrying signals are being sent concerning key issues relating to take-up. For example, are there not signs that the number of subscription-based packages that consumers are prepared to purchase to gain access to sport and films has reached saturation point? Consumer behaviour in this respect is potentially a key barrier to the take-up of digital television. One wonders, too—this is partly behind the potential restructuring in ONdigital—how much longer those who provide digital television set-top boxes can continue to do so free. Those things are expensive.
Those considerations prompt thought about the resistance referred to in the Consumers Association report—particularly in the households of elderly people, but also among some young adults who watch less television these days—to converting to digital and paying more than the licence fee for television programmes. Such considerations are reasons for encouraging the free-to-air channel development that I know that the BBC and ITV have studied, and that other broadcasters are also preparing.
The Government have a leading role to play in raising awareness—something that many hon. Members have alluded to today—and selling the benefits of digital delivery in the long term. Picture and sound quality are not the only issues. I have some sympathy with what the hon. Member for Lewes (Mr. Baker) said about radio, but I do not have time to develop that topic now. However, the opportunity to establish a range of additional, free-to-air channels should also be stressed. It should not be necessary for everyone to sign up to a monthly contribution to which the family budget might not stretch in the long term.
I agree with the hon. Member for Preseli Pembrokeshire that internet services are also part of the issue. The hon. Member for Lewes argued that the conversion programme is not comparable to the change from black-and-white to colour or 405 to 625; gosh, we are all getting old. It was a long time ago, but it does not seem like it. It is important to make a greater effort to raise consumer awareness about the issues in question.
I want to concentrate my remarks on stressing the important role of Government in relation to the regulatory framework. We welcome what has been revealed about the target date for analogue switch off. I suspect that the date will be nearer to 2010 than 2006. We need to end the confusion about what a digital television set is. We believe that there is a large role for industry to play in that. Digital television should mean digital reception, not analogue reception.
The Broadcasting Act 1996 established a competitive environment. It was a deliberate intention on the part of Government to encourage competition in the development of different digital television systems. However, that development is now hampered by the regulatory framework. A new communications Bill has been delayed for too long and is now an urgent task for the new Parliament. Changes are also necessary in the rules relating to ownership, and the hon. Member for Lewes mentioned the possibility of a single ITV, which I believe will become a reality.
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It is a matter of resources. We need competing infrastructures to drive down prices and increase innovation, as well as to pay for the major investment that will be needed to ensure digital take-up in every home in Britain. It will not be for the Government or the BBC to provide that. It must be provided by the industry, and the industry must be capable of organising itself in order to achieve that. It is equally important that the Government should recognise the important role of advertising and the need to support the advertising industry in its demands for continuing self-regulation against a tide of opinion in Europe in favour of a more regulatory framework. Without advertising revenue, no one will be able to provide the necessary investment, and advertising revenue will provide many more free-to-air channels.
On regulation, we also need neutral platform delivery and open access changes in the legislative framework. As I have often said—I hope that the Minister will forgive me if I repeat what I have said to her before—as a veteran of the Standing Committee that considered the Broadcasting Act 1990, that we missed a trick when we established the framework, which placed too much power in the hands of one super satellite broadcaster. That has caused difficulties in gaining access.
We need to end the confusion and the restrictions on what channels are available through different platforms. That is driven—understandably—by market share over platform delivery, but in the long run we must have a framework that allows viewers access to all the channels of their choice, regardless of origin. The new regulatory framework should strive for that. There are technical and logistical difficulties, in particular in geographical reach and equality of access, to which hon. Members have already referred, and the Government must continue to press for the digital signal to be strengthened.
I was heartened when the hon. Member for Sutton said—her remarks were echoed by the hon. Member for Preseli Pembrokeshire—that we must have a clearer view about how universal digital coverage will be delivered. I have already declared my interest in ITV, but hon. Members do not sufficiently appreciate that if we are to have universal digital delivery, a significant contribution will be made by terrestrial digital delivery. That will not be achieved by cable and satellite, or if it is, it will take an awfully long time.
Many of us represent rural constituencies and know that satellite dishes are banned in many parts of our constituencies, and not everyone wants a satellite dish on his or her house. I believe that the hon. Member for Sutton said that the television aerial on the roof provides all that is required. The hon. Member for Preseli Pembrokeshire mentioned shared aerials, and I agree entirely with what she said. If we want universal digital delivery and, eventually, the analogue switch-off that everyone is seeking to achieve, we must allow the terrestrial digital companies the opportunity to compete on fair and equal terms. I hope that I am not making too partisan a point when I say that the most pressing need is for the Government to address the issue of regulation. That, more than anything else, is what the Government can do to speed on the process. There must be an opportunity for real competition.

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In the mobile telephone market, the competitive framework and the level playing field for all operators have driven down the cost and created universal access to such a point that the problem now seems to be that consumers wonder why, if they already have a mobile telephone, they need another one. In a sense that is now the situation with television. People need to be convinced that, although they already have five or six television sets, they need to change them all to digital. That is why the awareness programme is important. In the end, that will be achieved by a more competitive environment in the television industry. We are all in agreement and I think that we can pursue the matter on a cross-party basis once the election is out of the way and my hon. Friends and I are, I hope, sitting on the Government Benches. If we want analogue switch-off to be a reality and not merely an aspiration, we have to ensure that the industry can provide what this House desperately wants it to achieve.
12.16 pm
The Minister for Tourism, Film and Broadcasting (Janet Anderson): I congratulate my hon. Friend the Member for North-West Norfolk (Dr. Turner) both on securing this important debate and on the determination with which he has pursued the matter on behalf of his constituents. Having visited his constituency, I know how important it is there. I can well understand the concern of people who cannot receive their regional ITV service and I hope that we shall be able to do something about that. Let me remind the House of what we said in the communications White Paper where we specifically referred to the issue:
"The potential of digital broadcasting provides an opportunity to look again, in consultation with the industry, at how best to address these problems. We intend now to initiate discussions on this issue with relevant broadcasting companies. Should any viable solutions emerge, we will consult members of Parliament and local communities in the areas affected about whether changes to services to resolve the problem would have the backing of the local population."
Since we published that White Paper, some discussions have taken place. I shall touch on them later. As my hon. Friend said, technically solutions exist; it needs a political will to make them happen. I assure him that that political will is there. He made a number of suggestions to drive the take-up of digital. I assure him that we have taken them all on board and they will form part of our deliberations when we publish a draft Bill, which I hope will be in the summer. The response to the consultation process has been very valuable. We recognise how important the issue is. The hon. Member for Ryedale (Mr. Greenway) mentioned an opportunity that he thought had been missed in the 1990 legislation. It is a complicated area, and that is one reason why the Government intend to publish a draft Bill.
The hon. Member for Ceredigion (Mr. Thomas) raised a number of issues, which I shall try to address. I agree with him about S4C; it certainly is a jewel in the crown. He referred to a recent series of animated tales from around the world. I believe that they were broadcast in conjunction with Channel 4. I had the pleasure of helping to launch that initiative, and I remember saying at the time that it would not have
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happened without public service broadcasting. I am very well aware of the contribution of S4C to diversity and access.
My hon. Friend the Member for Plymouth, Sutton (Mrs. Gilroy) mentioned the important contribution to her constituency by ONdigital, which employs around 1,400 people there. That is another example of the jobs that can be created by that means. The hon. Member for Lewes (Mr. Baker) and the hon. Member for Ryedale emphasised an important point: there are no political differences. We must use this digital revolution. We are united about the need to drive its take-up because it will mean more choice, better quality and a more efficient use of the spectrum.
The hon. Member for Lewes mentioned in particular ITV and the move towards one ITV company and expressed the hope that that would not diminish regional coverage or regional programming which is perhaps even more important. I remind him that ITV was born in the regions. I am confident that that will not happen. I speak as the Member of Parliament for a north-west constituency and we in the north-west are proud of Granada. He also mentioned digital radio. That is much further down the road. I hope that as the price of digital radio comes down, more people will take it up. There were some reasonable ones on offer last Christmas. We are hopeful that the same will happen this Christmas and encourage more people to buy them.
My hon. Friend the Member for Preseli Pembrokeshire (Mrs. Lawrence) also spoke about the contribution of ONdigital in her constituency. There are 800 jobs now, increasing to 1,100. She also mentioned the better quality programming that was available and the proliferation of channels. That is one good reason why public service broadcasting will be so important in this digital revolution. She also mentioned access to the internet, which I will touch on in a minute.
The hon. Member for Ryedale is much more knowledgeable about these issues than I am. He has a background in broadcasting. He emphasised the need to encourage free-to-air development and said that digital terrestrial would be the platform that would drive that. I could not agree with him more. I am grateful to him for his support on this. I can reassure him that the whole intention of the White Paper was to produce lighter regulation in order to ensure a dynamic market and protect services for the consumer. We understand the importance of that.
My hon. Friend the Member for North-West Norfolk was particularly concerned about those viewers in his constituency who cannot receive the appropriate regional service for their area. Although the priority in utilising limited spectrum is to ensure that as many viewers as possible can receive a service, the provision of correct regional services was also an important issue for the BBC and the Independent Television Commission in developing the present analogue transmitter network and we very much hope that the position can be improved with digital broadcasting. We recognise that there are problem areas where typically local news and features and other regional variations are not available to viewers, and we fully appreciate the frustration that that can cause. We hope that the development of digital television will offer some solutions.

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In our White Paper, "A New Future for Communications", which we published last December, we emphasised our commitment to the provision of regional programming. We fully recognise the important part that regional programming plays in identifying and reflecting the concerns and interests of local communities and we also believe regional programming to be a vital element of public service broadcasting in the UK and that viewers should be able, wherever possible, to receive the regional programming intended for their community.
Digital technology has the potential to provide a fresh opportunity to consider how best to resolve the problem of regional anomalies. We hope that that can be achieved before the full switchover to digital broadcasting. We have already initiated some discussions within the broadcasting industry. My hon. Friend the Member for Wirral, South (Mr. Chapman), who, sadly, is unable to be here today, has also been quite determined in his pursuit of that issue on behalf of his constituents.
Since the communications White Paper was published, ITV has announced that it has secured transponders on an Astra satellite that will provide enough capacity to enable it to provide 16 regional ITV services. I understand that a number of technical issues are still to be resolved and that ITV hopes to launch its services on satellite by the end of this year. Of course, we recognise that viewers who do not have digital satellite receivers may face additional costs, but it is an encouraging development and will be an important step towards increasing access to the correct regional services in problem areas.
We are also keen to find digital terrestrial solutions to regional anomalies. For example, it may be possible to take advantage of the fact that digital technology enables multiple broadcast services to be carried simultaneously on a single frequency channel. In theory, some digital transmitters might broadcast more than one regional service—one appropriate to the transmitter's location and an out-of-area service to resolve a regional anomaly. It is still not an easy technical option. In particular, it would require sufficient digital capacity to accommodate additional programme services on multiplexes that are already full. It remains one of the possibilities being explored.
Several hon. Members stressed the need to drive the take-up of digital. I assure them that the Government are similarly gripped by the need to do so. We are working with the broadcasting industry on a number of fronts to develop digital television in the UK. Work is under way to equalise coverage across all six digital terrestrial multiplexes, which aims to increase the core coverage to 73 per cent. of the UK population.
The Government are also working with the ITC, the BBC and the broadcasting industry on how to extend digital television services further to achieve the best possible coverage and reception. To that end, the Government recently wrote to digital broadcasters, seeking their commitment to plans to double the power of digital signals on eight key transmitters. The plans were developed by the ITC and will improve the signal quality, giving more homes access to terrestrial free-to-air and subscription services. That announcement will be widely welcomed by hon. Members who have spoken about the issue today.
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On consumer issues, we are aware of viewers' concerns about switchover to digital television and we need to ensure that consumers are made fully aware of all aspects of digital television, especially to enable them to make informed decisions about purchasing equipment and services. We have been working closely with broadcasters, manufacturers, retailers and consumer groups to ensure that viewers receive accurate and sensible information and that misconceptions are corrected promptly. A set of clear and simple messages has been agreed, which can be used to promote and encourage take-up. Broadcasters have launched information leaflets on free-to-air digital television, which are available to consumers from electrical retail outlets and from broadcasters.
The problems of people who live in blocks of flats with a communal aerial have been mentioned. My right hon. Friend the Secretary of State and I were aware of the problem some time ago. It is interesting to note that 20 per cent. of the population live in such housing. My officials are in discussions with the Local Government Association, the Housing Corporation, the National Housing Federation, the ITC and other Departments to ensure that landlords and tenants are informed about the options for receiving digital television. Local authorities have an important role to play. Some are more advanced in that respect than others. We continue to liaise with the Local Government Association to do whatever we can to drive that agenda forward.
The Government are particularly keen to ensure that consumers can shop for digital television sets with confidence and are not misled into buying sets with digital features such as digital sound, under the mistaken impression that they are actually getting a digital television. Following discussions with television manufacturers, retailers and broadcasters it was agreed to promote the DVB—digital video broadcasting—logo as a means of identifying televisions that can genuinely receive digital transmissions.
UK manufacturers and retailers are also working together to ensure that all new digital televisions carry the logo, and that sales staff are trained to understand and explain the advantages and differences of digital televisions over both analogue and so-called "digital ready" sets. The Government announced this initiative on 27 March. Since then, the DVB logo has been given wider promotion on the ITV network.
The Govt also recently announced plans for a programme providing a series of neighbourhoods located across the country with free conversion to digital television. Our aim is to help both Government and industry to understand better the practical and social issues that people face in deciding whether to switch from their existing analogue to digital television. We expect that the first digital neighbourhood will be identified in the next two months and actioned in the next six months. One important part is that people in the pilot areas will also be able to use their television set to access interactive internet services, including learning and shopping, and send and receive e-mail—
Mr. John Cummings (in the Chair): Order. We must move on to the next debate.

Electronics (Northern Ireland)
12.30 pm
Mr. William Ross: It is sad when Ministers are cut off in full flow, just when they are getting to the bits and pieces that some hon. Members find interesting, but perhaps the Minister for Tourism, Film and Broadcasting will complete her speech elsewhere, so that we can hear about the exact long-term effects of digital television.
Similar to digital broadcasting is the future of Northern Ireland's electronics manufacturing industry, and I am grateful for the opportunity to debate it, although somewhat surprised. I am sure that this debate has been allowed only because of the United Kingdom-wide implications of what is happening in the electronics industry in Northern Ireland and the unemployment issues associated with it in Northern Ireland, the rest of the UK and throughout the world.
The subject is of particular concern to my constituents because of the recent announcement of job losses at the AVX plant in Coleraine. Some 95 people were laid off a month ago, and it is feared that 150 more will lose their jobs in the near future—protective notices have been issued. As the Minister will know, the presence of AVX in Coleraine is vital for the town, because the firm employs around 1,300 people, many of whom are highly skilled and educated people. If AVX and other electronic manufacturing companies are to hold on to their most talented workers and attract other equally talented individuals, stability in the industry is essential. Unfortunately, that stability has been lacking recently.
The problems at AVX are far from unique in Northern Ireland. Earlier this month, Valence Technologies announced that it would be laying off 181 workers at its plant in Mallusk. Redundancies have been announced at Leaf Technologies in Newtownabbey, and it has emerged that 270 jobs are to go at the Nortel plant in Monkstown. Additionally, Nortel announced a total of 20,000 job losses at its plants across the world. That unfortunate statistic demonstrates the crux of the problem—the volatility of the global market in electronic components. Some hon. Members who can remember the 1960s will recall Northern Ireland putting many of its eggs in the basket of man-made fibres. They were all quickly broken, and we do not want the same situation to arise.
When one hears of job losses on that scale in other industries, one might be forgiven for concluding that the industry in question is in terminal decline, but that is not the case in the electronics manufacturing industry. We are living in the electronic age and demand for products made by companies such as AVX—miniature electronic components for mobile phones and computers, for example—is still high throughout the world. Despite that, the industry is going through a difficult period. As I said, the market is volatile, and that has been demonstrated most graphically recently by the continuing fall in stocks in global technology and telecommunications. So, what can be done to introduce a measure of greater stability for the work force, product lines and sales of such companies?
Since devolution was restored to Northern Ireland, we have been fortunate to have Sir Reg Empey as Minister of Enterprise, Trade and Investment. That role
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fits his talents especially well, and he has been the deserving recipient of quite a lot of praise from all quarters for his efforts on behalf of every shade of opinion in the Province.
As soon as I was informed of the first tranche of job losses at AVX, I contacted Sir Reg to discuss the problems at the plant, and we have kept in close contact since then. However, as the difficulties are far from unique to the Province, I thought that it would also be useful to seek the views of a Northern Ireland Office Minister, who could outline thoughts about the problems of the electronics industry from a Government perspective.
AVX has been in Coleraine for quite a long time. Its ownership has changed more than once, but the management is excellent and comprises high-quality people, who are working hard with trade union representatives to explore every available option to reduce costs and safeguard jobs. The honest and open nature of those discussions is to be commended and can only help to maintain the unity of purpose between management and workers at the plant. In the longer term, management and workers at AVX should be confident of an upturn in the company's fortunes.
As I said, the industry is volatile: there have been considerable increases in employment followed by quick drops, which is what concerns workers more than anything. However, AVX is well known for its commitment to new products and it has a portfolio of high-calibre customers throughout the world. With a well-focused marketing campaign, the firm will, in time, be able to combat the difficulties in the global market and resume its growth with corresponding and, I hope, long-term employment prospects for even more people in the Coleraine area.
To speed that process, Government assistance is required. The Northern Ireland Executive will play their part, and Sir Reg Empey is already doing what he can, but what on earth are the Government doing? Although these matters are devolved, the Government cannot escape some measure of responsibility throughout the United Kingdom.
As the Minister well knows, there is a large number of electronics manufacturing plants in Great Britain, and I am sure that the Government are as concerned as I am about the state of the global market and the on-going consequences of that. The number of redundancies announced in recent months in the electronics industry in Northern Ireland totals about 1,000, and I am told that that would be the equivalent of 30,000 lay-offs in the electronics industry in Great Britain. That statistic puts the impact of the problem in the Province into perspective. Many jobs are involved in the electronics industry, which is a growth industry. It has expanded extremely rapidly during recent years, and I believe that it will go on expanding, but we do not like to see downturns.
The latest especially vivid demonstration of the poor state of the global market came on Friday, when Ericsson, the Swedish-based telecommunications company, announced that 12,000 staff would be made redundant. That brings the total number of job losses in the global telecommunications industry in the past 10 weeks to more than 100,000—an astonishing and horrifying number. Mr. Kurt Hellstrom, Ericsson's chief executive, said on Friday that we were witnessing

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"the fastest dive in the industry that we have ever seen."
The number of redundancies certainly confirms that.
The global downturn seems to have come about because of a number of factors. There is a fear of recession in the United States of America, and it is sometimes perception rather than the actuality that matters. That fear has, in turn, adversely affected markets in Asia and, with that, orders for companies such as AVX, because all purchasers of the relevant materials are looking some months ahead. As we all know, however, they sometimes get things wrong rather than right.
The events at Ericsson have demonstrated the particular problem with the mobile phone market. The explosion in sales of mobile phones seems to be over, at least for the moment, and the recent announcement by the largest UK network providers that the cost of calls is going up underlines the fact. We are all aware of concerns about the colossal amounts paid by such companies for licences to provide third generation services, when no one is sure whether there will be sufficient demand for them. It is the third generation of mobile telecommunications that would have provided the market for the electronic components that were mentioned.
The global computer market is also in a particularly difficult state with sales of personal computers also on a slide. Such developments have a huge impact on the fortunes of companies such as AVX. However, my experience of PCs is that as soon as one is bought and taken out of the box, it becomes obsolete and one has to start thinking about buying the next one, so the slide is unlikely to continue for long. The pressures to buy a new computer system will continue and the sector will soon experience an upturn.
During recent weeks, I have been in contact with several people at AVX—mainly people working on the shop floor, whose opinions I wanted to ascertain. As can readily be imagined, morale is low at the moment. I encountered one young man who recently got engaged. He had obtained his degree in England and returned home to Coleraine to work at AVX. He thought that he had a long-term job, but sadly soon found himself in a position where he had to return to Great Britain to find a decent job to provide a living for his fiancée, himself and, hopefully, his children in the not too distant future.
Such an eventuality is a great loss to Coleraine and to Northern Ireland as a whole because we want to keep highly skilled graduates in the Province. Education is important for people to gain the technological skills that they need at their fingertips. Northern Ireland's manufacturing industry and the long-term prospects of the Province depend on it. It is a shame when people such as this young man—there are many more like him—leave their local areas in Northern Ireland.
The brain drain from the Province to more distant parts has thankfully been stemmed in recent years and I hope that that will continue as manufacturing industry develops and more young people stay at home and find employment in industries with good prospects of expansion. Sadly, the uncertainty over long-term job prospects—at AVX, for example—will do little to help the problem or to encourage people to establish roots in their home territories and stay there.
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At the weekend, I was quoted in the local media as saying that AVX is the jewel in Coleraine's crown. That was underlined recently when the company was presented with the Queen's award for enterprise for its success in international trade. It is a successful company with many highly skilled workers. I want to see its success continue and I hope that the Government will play their part in helping AVX to maintain its remarkable achievements in the future. For that to happen, the work force must be able to look ahead with anticipation rather than dread. I therefore hope that the Minister will today have something positive to say to me and to the workers and people of Northern Ireland.
12.44 pm
The Parliamentary Under-Secretary of State for Northern Ireland (Mr. George Howarth): I congratulate the hon. Member for East Londonderry (Mr. Ross) on his good fortune in securing a debate on this important subject. I share his surprise that the debate was allowed, but it is important to have the opportunity to debate the UK-wide economy, even though there are important regional differences that are rightly reflected through the workings of devolution.
It is also important to place on record the healthy performance of the Northern Ireland economy in recent years. I am not saying that there are not still problems—I will address those in a moment—but all the key indicators point to a healthy economy, consistently outperforming other regions of the United Kingdom and competing successfully with other European countries. Northern Ireland has enjoyed a good rate of economic growth during the past 10 years and, with an unemployment figure of 5.9 per cent., compares favourably with other parts of the European Union. The high unemployment of the years of the troubles is thankfully now receding, although it is apparent, as the hon. Gentleman made clear in his speech, that there are still problems that must be overcome.
Northern Ireland has benefited during the past few years and particularly during the life of this Parliament, and that is well illustrated by the confidence that has been shown by companies that are investing in Northern Ireland. More than £2 billion in investment was announced or promised by companies in Northern Ireland between 1996–97 and 1999–2000, of which some £500 million was inward investment. The hon. Gentleman raised the problems of AVX in his constituency. That example shows that the economy in Northern Ireland is not immune from outside events, although in macro-economic terms there is a good story to tell. Electronics and technology companies in Northern Ireland, as in the rest of the United Kingdom, have been affected by the worldwide slowdown in the economy, to which the hon. Gentleman referred.
Foot and mouth disease and BSE have affected Northern Ireland's agriculture, tourism and related industries. Dealing with those difficult problems is now primarily a matter for the Northern Ireland Executive and Assembly and I am confident that Northern Ireland Ministers will continue to build up the strong and competitive economy that exists in Northern Ireland.
The hon. Gentleman asked what the Government are willing to do to help the Executive and Ministers in their efforts on that front. We have been, and will continue to

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be, helpful in several areas, mainly to do with the general manner in which the macro-economy is managed. For example, it is important that the success that Northern Ireland and other parts of the UK have enjoyed is allowed to continue. That means building a strong and competitive economy to enable companies in the UK to compete around the world and, of course, with other European countries. A key to that is low interest rates and inflation. The Government and the Chancellor have been successful in that area, particularly in terms of controlling inflation, and it is our intention to continue to do that.
The right hon. Member for Upper Bann (Mr. Trimble) has been present throughout the debate. He is the First Minister, and I believe that he will accept entirely that the Secretary of State for Northern Ireland, the Minister of State and I are willing, available and more than happy to help Ministers in the devolved Administration. We remain willing to raise specific issues on behalf of the Executive within Whitehall.
I regret that I cannot respond directly to the hon. Gentleman's specific points on the electronic manufacturing industry in Northern Ireland, as responsibility for economic matters in Northern Ireland now rests in the very capable hands of the Northern Ireland Minister of Enterprise, Trade and Investment, Sir Reg Empey. The matters raised by the hon. Gentleman are therefore no longer a matter for the Secretary of State for Northern Ireland.
We are, of course, happy to work alongside Sir Reg Empey and other Ministers to address the points raised during today's debate. It is appropriate that when we pass on the points that have been made today to Sir Reg, we also pass on the House's good wishes for his continued success in building up Northern Ireland's economy. Such a relationship already exists between hon. Members present here today and that work is continuing. Although it is a devolved issue, the key principle is that we are willing to be as helpful and accommodating as possible with Ministers in the devolved Administration.
12.51 pm
Sitting suspended.

Queen Elizabeth Hospital, Birmingham
1 pm
Mr. Steve McCabe: I begin by acknowledging that there is a problem and a need to make a decision about the future of transplant facilities in this country. There has been a reduction in the number of transplants, largely because fewer organs are available as medical advances and road safety measures reduce the number of early deaths, something for which we should all be grateful. The Royal College of Surgeons was right to draw attention to the number of doctors who should be employed in transplant units, their work load, and the need to ensure that their skills are used on a regular basis.
The present size of units is based on historical accident, and to a large extent on the contract culture that was a dominant feature of the previous Government's approach to the NHS. In the early 1990s, the Department of Health recognised that there was a problem and envisaged evening out the size of units over time. Sadly, it never introduced mechanisms for achieving that, hence the situation in which we find ourselves today.
I regret to say that there is a strong feeling in Birmingham and the west midlands that the current National Specialist Commissioning Advisory Group's proposals, which pose such a threat to Birmingham, represent smash and grab opportunism by the established players in London and the south-east. As I have said, I recognise that the number of available organs is an issue. The Government recognise that even if their 10 per cent. target to increase donors is achieved, it will result in only about 30 additional transplants nationally per year.
There can be little argument that there is a need to examine where transplant resources are located and how they are used. We need to do everything in our power to increase the potential for organ donation and I welcome the Government's moves in that direction. We also need to ensure that any review treats different parts of the country equally, and takes account of issues such as geography, existing health factors per region and access to treatment. I do not accept that a fair review can simply focus on the traditional claims of established units in London and the south-east.
Birmingham has a strong demographic and institutional argument for retaining its transplant facilities. Our centre is sited in one of the largest conurbations in the United Kingdom. We already have an institution with excellent organ transplant infrastructure. The unit recently completed its 250th heart transplant and its 2,000th liver transplant. The unit has surgeons such as Robert Bonser, Tim Graham, Ian Wilson and Bruce Keogh, and cardiologists such as Sarah Thorne. We have first-rate people of whom we can be really proud. There is so much to be optimistic about in terms of the NHS in Birmingham.
Mr. Richard Burden: Looking to the future for Birmingham, a new hospital has been announced, which will be a great addition. On a shorter time scale, there will be a new cardiac unit, which also promises to be a great addition to the Queen

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Elizabeth-Selly Oak complex. The opening of that unit is a further reason for keeping the transplant facilities in Birmingham.
Mr. McCabe: I entirely agree with my hon. Friend. We have an excellent new cancer unit and several leading cancer experts. As he says, a new, 33-bed cardiac surgery critical care unit will open, on schedule, in about eight weeks, which I understand will be the largest in Europe. The university hospital trust also received strong encouragement to establish what is only the second adult congenital heart disease programme in the country. Adult survivors of congenital heart disease are, as I am sure you are aware, Mr. Cummings, extremely likely to require transplants later in life, yet, astonishingly, after encouragement was given for the setting up of the programme, the NSCAG proposals would mean, if not the removal of the surgical arm, at least amputation of all but a stump. They would severely reduce a key area of potential treatment.
Birmingham, with all that it has to offer, is considered the right environment to host a centre for defence medicine for the men and women of our armed services. It may be the right place to treat them, but it will not be the place to go if one needs a heart or lung transplant.
Mr. Paul Keetch: I congratulate the hon. Gentleman on obtaining the debate. He mentioned heart and lung transplants and he will know that the excellent centre in Birmingham covers not only the metropolitan west midlands but the rural parts of my constituency, and extends into Wales. It is a very large area. My constituent, Keri Davies, who is 47 years old, has been waiting three years for a heart and lung transplant. The additional stress of thinking that the unit might be closed has worsened his condition. Indeed, he was taken to hospital in Hereford last night. Does the hon. Gentleman agree that the Government must respond urgently and that as soon as possible they should decide to keep Birmingham going?
Mr. McCabe: I take note of the hon. Gentleman's comments and I see real urgency in the situation.
My right hon. Friend the Secretary of State recently gave the go-ahead for the building of Birmingham's first new hospital since 1938, for which we are all extremely grateful, but if NSCAG gets its way we shall be building a brand new hospital denuded of a key treatment facility. That will mean that patients from the midlands, Wales and the surrounding area, such as the constituent of the hon. Member for Hereford (Mr. Keetch) who require transplant surgery, will have to travel weekly to Harefield or Papworth, two of the least accessible hospitals in the country. In some cases, the travelling time will be so long that it will deny people the chance of a transplant even if a suitable organ becomes available.
One of the strangest things about the NSCAG proposals is that not only do considerations of geography, access and travel appear to have been ignored in their preparation, but most other aspects of transplant activity also seem to have been discounted. Those include assessment, donor ret retrieval and early and late follow-up activities. In fact, the proposals appear to show bias in favour of the status quo and they are heavily weighted in favour of stand-alone units rather than units that are part of a multidisciplinary service.
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That seems to be rather at odds with all recent advice, and contrary to the philosophy that we are encouraging elsewhere in the health service.
I do not know whether the Minister can help, but I find it difficult to explain to my constituents that the review has been fair and serious when those involved seem to have ignored any significant reappraisal of donor zones. If, for example, we were to increase Birmingham's area of activity to incorporate the east midlands, the Cardiff-Newport area of south Wales, Bristol and Oxford, we could change the donor catchment area and preserve the Birmingham unit. I am not trying to pit one unit against another. A proposal like this would result in a reduction in Papworth's influence in the east midlands, but that could easily be compensated for by a similar boundary review in the south.
As I said earlier, I agree that the Royal College of Surgeons was right to draw attention to the number of surgeons needed for each unit and the volume of work for each unit, but is it seriously being suggested that the only way to address such issues is to close down a highly successful solid organ transplant unit, which serves 6 million to 7 million people? Has no one ever heard of tele-medicine or video conferencing? Is it impossible for highly trained surgeons, whose skills we want to protect, develop and enhance, to travel occasionally to another hospital to perform or assist in a transplant operation? After all, the NSCAG proposals envisage sick people travelling hundreds of miles every week to obtain essential treatment. Would not such an approach be more in keeping with the spirit of partnership and co-operation—rather than competition—that we want to encourage in the health service?
Mrs. Caroline Spelman: I congratulate the hon. Gentleman on securing a debate on this important issue. My point relates to his argument about organ donation zones. The reduction in the number of transplant centres, which would effectively do away with a transplant centre for a population of 6 million to 7 million, can be compared to leaving Denmark without a heart transplant centre. Is it not also inextricably linked with the number of intensive care beds, because keeping organs ready for transplant becomes much more complicated as the number of transplant centres is reduced? That is an important consideration.
Mr. McCabe: I emphasise the point that has been made about the catchment areas for donor harvesting, which was borne out by the report of the Royal College of Surgeons. It is also important to acknowledge that the work load of a cardiothoracic surgeon is only a fraction of his or her total operative commitment—they do plenty of other work. None the less, it is a key sub-specialty, and a decision to rob Birmingham of such facilities will mean that we will lose highly qualified staff and have trouble attracting others. It will also have an unwelcome impact on the successful collaboration between the hospital and the nearby medical school.
The directors of the transplant programmes at Birmingham, Manchester and Sheffield are all on public record as stating that, if given the go-ahead, the proposals will lead to deteriorating rather than improved patient access, particularly for the patients of the mid-north, midlands, south Wales and the south-west.

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There is a solution, which many more people than the 15 members of NSCAG are now proposing, and that is to agree to five units and adjust the catchment or harvest donor areas so that there is more equal distribution. That was originally envisaged as long ago as 1992, and it is perhaps regrettable that the then Government did not act when the problem was identified. That solution would also allow all the retained units to achieve the optimum annual number of transplants—about 50. It would also address problems relating to travelling, retain a wide spread of surgical skill across the country, and show those of us who do not live in London or the south-east that the people who manage and advise on the health service take our needs into account, as well as the views of the old-boy network, with its contempt for those of us who live north of Watford.
I am grateful to have had the opportunity to raise this matter on behalf of the people of Birmingham and my Birmingham and west midlands parliamentary colleagues. I ask the Minister to try to ensure that the full extent of the Birmingham situation is understood when the matter is finally decided on, and that the arguments in favour of five centres are seriously considered before a decision is taken. I also ask her to support the request made by Birmingham Members to meet with the Secretary of State so that we can put our case directly to him.
1.15 pm
The Parliamentary Under-Secretary of State for Health (Yvette Cooper): I congratulate my hon. Friend the Member for Birmingham, Hall Green (Mr. McCabe) on securing the debate. As I am sure that he is aware, this is the third debate in this place on the future of the national cardiothoracic transplant service. We have already had debates on the centres in Sheffield and Manchester. My hon. Friend is right to point to the strengths of the case for his own area. We have had representations from Yorkshire and Manchester Members, in particular from those in whose constituencies the services are situated. We have also received extensive representations concerning the Birmingham centre from Birmingham Members, including those in the Chamber this afternoon—my hon. Friend the Under-Secretary of State for Health, the Member for Birmingham, Edgbaston (Ms Stuart), and my hon. Friends the Members for Birmingham, Selly Oak (Dr. Jones) and for Birmingham, Northfield (Mr. Burden).
The debate concerns the future of organ transplants at the Queen Elizabeth hospital, and it is worth reminding hon. Members that the hospital provides three important organ transplant services. My hon. Friend the Member for Hall Green was right to refer to the renowned liver transplant unit, which, on 7 July in Birmingham, will celebrate its 2,000th liver transplant. I should like to take this opportunity to congratulate Professor Paul McMaster and his team on an outstanding achievement that we all applaud. We all wish the liver transplant team well for what should be a wonderful day. The Queen Elizabeth hospital also has an important renal transplant unit, which we hope to see expanding as a result of the overall reorganisation of the organ transplant services.
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My hon. Friend made it clear that the debate is about the cardiothoracic transplant service. It is also worth making it clear that the debate concerns cardiothoracic transplants rather than the wider issues around cardiac care. The cardiac unit at the Queen Elizabeth hospital already has a distinguished record of research into heart failure and is recognised for its work in aortic aneurysm surgery. A new £13 million expansion of the cardiac unit at the hospital is due to open in a matter of weeks. That will enable the unit to perform an additional 450 cardiac operations, which will help it to meet the priority targets set out in the national service framework for coronary heart disease. The cardiac unit will build on its many strengths and continue to be at the forefront of developments in the treatment of cardiac disease. There will be further opportunities to develop and expand cardiac services when the recently announced £291 million replacement for the Queen Elizabeth hospital is built in a few years' time.
My hon. Friend concentrated on the issues relating to the future of cardiothoracic transplants. That is a very specific area about which there has been considerable debate and discussion, over a long period. That discussion stems from a problem with organ donation by younger people. As I have made clear in previous debates, the Government have restated their commitment to do everything possible to maximise organ and tissue donation and to maintain the very high standards of our organ transplant services. The Secretary of State spelt out that commitment at an organ and tissue donation summit on 27 February, at which he announced an NHS action plan intended to double the number of people on the organ donor register by no later than 2010, and to double the number of kidney transplants by 2005.
We must also recognise that there is a longer-term underlying problem of organ donation which we must address. Improvements in road safety and prevention of strokes in younger people are important health gains and are to be welcomed. For example, between 1990 and 1999, deaths from road accidents in people aged 16 to 59, which is the usual age for heart and lung donation, fell by almost 40 per cent. That is clearly good news, but it has an impact on organ donation. In the past five years, organ donors under 60 have fallen by 15 per cent. That fall could have been greater were it not for the dedication of staff in intensive care units and the efforts of intensive care specialists, transplant co-ordinators and transplant teams in identifying and using available donors.
Mr. Keetch: I appreciate that the Minister and the Under-Secretary of State for Health, the hon. Member for Birmingham, Edgbaston (Ms Stuart), cannot create organs for transplant out of nowhere, but are the Government giving any consideration to adopting the French system, whereby people must opt out of organ donation and there is a presumption of donation if one is tragically killed? Surely that would alleviate the problem overnight.
Yvette Cooper: The Government have considered a wide range of possibilities to increase organ donation, including at the recent summit to which I referred earlier. I am informed by my hon. Friend the Under-

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Secretary that there have been some problems with the French model. I am not aware of the details, but I shall write to the hon. Gentleman on that matter.
The fall in younger organ donors has meant a year-on-year reduction in the number of cardiothoracic transplants. Cardiothoracic transplantation has been designated as a national service since 1986. By 1991, there were seven adult centres in England, and the intention was to ensure that each centre performed at least 50 transplants a year. That followed a major expansion of the service in the late 1980s, which was built on the belief that the number of organs would continue to increase. Four new adult cardiothoracic transplant centres were designated at that time.
The Queen Elizabeth hospital in Birmingham is one of those centres. Last year, it performed 21 of the 290 heart, heart and lung and lung transplants performed in the seven English adult cardiothoracic transplant centres. One of the other new centres was St. George's hospital in London, which carried out 10 transplants before its programme was suspended following a run of poor results. The St. George's programme is the subject of an investigation by the Commission for Health Improvement. The other two new centres are the Wythenshawe hospital in Manchester and the Northern General hospital in Sheffield. The three original centres were Papworth hospital in Cambridge, the Freeman hospital in Newcastle and Harefield hospital in Middlesex. Those three hospitals already perform more than 50 transplants a year. The work to increase organ donation could lead to an additional 30 transplants a year, but even with that increase, there is little prospect that all seven adult centres could ever reach the original target of 50 transplants each a year.
When considering how to modernise transplant services, we accepted the recommendation of the Royal College of Surgeons on minimum staffing levels for transplant units. That is an extremely important factor. Because so much organ transplantation takes place at night or over the weekend, the Royal College of Surgeons recommended that surgeons should not be on call out of normal working hours more often than one day in four. That requires a minimum team of five surgeons. At the time of the report, only two of the seven centres had at least five transplant surgeons. If those surgeons are not able to perform enough transplants each year, it will be more difficult for them to maintain the necessary skills. If the current situation continues, there is a risk that members of transplant teams will begin to lose their skills and standards will fall. For the sake of current and future patients, we must ensure that each transplant team is well staffed, has access to all the support it needs and performs enough operations to maintain a high level of skill in all the members of the team. Patients who undergo such complex treatment as a heart transplant need to be reassured that their surgeons have the up-to-date skills and experience to treat them effectively. I should make it clear to the hon. Member for Meriden (Mrs. Spelman) that this is a debate about skills and staffing—that is why the reforms have been proposed—not a debate about intensive care.
Mrs. Spelman: However, the availability of intensive care beds is absolutely critical to any transplant
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programme. It is one of the major reasons why there is concern about ability to reach transplant targets, particularly in relation to renal transplant.
Yvette Cooper: The hon. Lady is right to say that intensive care provision is critical in order to maintain, if not increase, the numbers of donors. That is one of the reasons why we have increased the provision of intensive care. However, that does not affect decisions about the services, the appropriate configuration of services based on skills and staffing recommendations, and the need to maintain the appropriate level of skills among all those who are carrying out such complex operations.
The NSCAG is responsible for advising on which services should be provided nationally. The group has considered the impact of those factors and last year recommended that the national cardiothoracic transplant should be delivered in future from only four centres in England, which would allow each unit the optimum infrastructure to support a programme of about 50 heart transplants. Each surgeon would then be able to perform, on average, 10 heart transplants a year. That size of programme would maintain the skills of the whole multidisciplinary team and ensure that organ retrieval teams were available to retrieve and use all suitable organs. The NSCAG also recommended that, to minimise disruption to existing services, the two units that already have sufficient surgical staff—Papworth hospital in Cambridge and the Freeman hospital in Newcastle—should remain designated, that the transplant services based in London should be consolidated into a single centre and, finally, that a fourth national centre should be created by merging the three smaller transplant programmes provided by the Birmingham, Manchester and Sheffield centres. Those recommendations are fully supported by many organisations, including the Royal College of Surgeons, the cardiothoracic transplant advisory group of UK Transplant, and Dr Roger Boyle, the director for heart services.
On the basis of the evidence that we have been given, the Government have agreed that the principles are right and that this reconfiguration of the service is necessary if we are to maintain the high quality of one of the best cardiothoracic transplant services in the world.
The decision still has to be made about the site of the fourth national centre, and we recognise the need to make it as early as possible to remove uncertainty. However, it is also critical that we take the right decision, which means ensuring that it is made on the best available evidence. We have asked for a detailed study of the three sites to assess the impact of a large team on the capacity of centres, to look at the potential capacity, and to assess other factors, such as access to patients, which my hon. Friend the Member for Hall Green mentioned as being so important. We are waiting for the final assessment to be submitted and we shall issue a document setting out proposals to inform the public and to seek comments. I assure my hon. Friends and other hon. Members that there will be opportunities for them to make further, more detailed representations when those proposals are put forward. During that process, we shall aim to keep the disruption of patients and transplant teams to the minimum. Patients on the waiting list will, wherever possible, be treated by the

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team that they know. We shall support patients as much as possible through any transitions that need to take place.
It is a difficult decision. My hon. Friend asked if I would pass on requests for a meeting with the Secretary of State. I shall certainly do that and get back to him.
Dr. Lynne Jones: Will my hon. Friend respond to the request of my hon. Friend the Member for Birmingham, Hall Green (Mr. McCabe) that the Government look at the possibility of retaining five centres, given the fact that the Government are intending or attempting to increase the numbers of heart transplants in the future?
Yvette Cooper: The assessment that has been made already has been done on the best available evidence. It has also taken account of the potential and our determination to expand the number of organ transplants. The recommendation was made to us, and we have accepted its principles. My hon. Friend and other Birmingham Members will have the opportunity to make further representations when the detailed proposals are drawn up, and I hope that, once the decisions are made and we are able to proceed, as much as possible will be done by all the trusts and centres involved to minimise any difficulties that may arise.
Mr. John Cummings (in the Chair): Order. I regret that we must move on.

Oxted and Limpsfield War Memorial Hospital
1.30 pm
Mr. Peter Ainsworth: I listened with interest to the previous debate about the problems of the health service in Birmingham. I have secured a debate on an issue that affects far fewer people, but is none the less creating acute anxiety in my constituency. I am grateful for the opportunity to return to the subject of Oxted and Limpsfield War Memorial hospital, which was last debated in the House on 1 July 1998, although I very much regret the need to raise the matter again.
The Minister will no doubt have read her brief on the issue, and will be aware of the hospital's history. She will be aware that it was the last war memorial hospital built in England, and that it was established by means of public subscription. The plaque at the entrance to the hospital was inscribed:
"This hospital commemorates the men and women of Oxted and Limpsfield who in the Great War 1914–1918 gave faithful service to God, King and Country. To the living, our thanks, to the Dead our unceasing remembrance."
Those are emotive words, which are not to be lightly dismissed. Of equal importance are the service that has been offered to generations of local people, who benefited from the presence of the hospital in their community, and the wonderful work of its staff since 1937.
When I last called a debate in Parliament on the future of Oxted hospital, in July 1998, the position was bleak. Despite the Government's welcome promise to devote resources to the provision of high-quality local community hospitals, Oxted hospital was known to be in a state of physical disrepair. It had been the victim of dither and delay over the implementation of a redevelopment scheme, which had been announced by the then Minister of State, who is now the Secretary of State, in September 1997. I dealt then with the events leading up to this unsatisfactory state of affairs. My purpose today is to address what has happened since, and to provide the Minister with an opportunity to answer questions about what will happen next.
If the situation was bleak three years ago, it is now grim. This is a story of broken deadlines, broken promises and broken hopes. Let me remind the Under-Secretary of what the then Minister of State said on 1 July 1998. He said:
"When I made my decision to approve the proposals by East Surrey health authority for the re-provision of Oxted hospital, I did so on two firm conditions, and I expect those conditions to be fulfilled in full. The first was that a viable private sector nursing home partner could be found; the second that adequate provision should be made at East Surrey hospital in Redhill to absorb the likely number of elderly patients being admitted there from the Oxted area."—[Official Report, 1 July 1998; Vol. 315, c. 334.]
The deadline for meeting those conditions, originally December 1997, was later extended to May 1998. It is now three years since that deadline expired, and I would be grateful if the Minister would state today whether there is any deadline in place at all, and, if so, whether it will mean any more than previous deadlines set on the matter by this Government.

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On 10 September 1999, the Minister wrote to me, saying:
"Our clear view is that it is now a matter for the local NHS to implement the agreed plan."
However, it has failed to do so and, despite her attempt to shrug the matter off, it has again become something to which Ministers must give their full attention. What can she say about the present state of negotiations with a private sector nursing home partner? In her letter to me of 27 March this year, she said:
"I am advised that officials at the South East Regional Office of the NHS Executive are working closely with the Trust to ensure that the full business case for the new development should be received by June. It is anticipated that building work on the new site would hopefully start before the end of this year."
Is the Minister still confident that a business case will be put in place by June? When does she think that the trust will be in a position to sign a contract with a nursing home partner? Will the Under-Secretary confirm that she remains hopeful that the building work on the new hospital will start this year? Will she give a categoric assurance that the Government remain committed to a replacement hospital in Oxted? That question must be asked because, as the Under-Secretary will know, the worst fears of many were confirmed on 6 February when the chief executive of the Surrey and Sussex Healthcare NHS trust suddenly announced that the hospital was to close without consultation. The reasons given were dilapidation and the safety of staff and patients. It was known eight years ago that the buildings were in poor repair. For eight years, local people have worried that, without major refurbishment or redevelopment, they would be left with nothing. I have to tell the Minister that the nothing option is not remotely acceptable to my constituents, who look to the Government to fulfil the promises that have been made.
Matters have not been helped by the management or financial position of the NHS trust itself. In 1998, the Surrey and Sussex Healthcare NHS trust was labouring under a deficit of some £4 million. Three years and three chief executives later, the deficit has grown to nearer £10 million. I would be grateful if the Minister would confirm the current figure in her concluding remarks.
Without doubt, the appalling finances of the trust have been made worse by the extraordinary decision, announced a few weeks ago, to suspend the proposed merger of health services provided at Crawley and Redhill. It is difficult not to regard that decision, which is contrary to clinical advice and financial common sense, as anything other than a political scam. I will not go into that today, but I mention it because it places a further unexpected burden on an NHS trust that is already saddled with mounting debts, unacceptable waiting times and obligations that it is struggling to meet.
If the trust did itself no favours by announcing the closure in the absence of any positive news about the hospital's future, it compounded its reputation for poor judgment by attempting, against advice, to hold a public meeting to discuss its decision in the hospital building. Nothing could better illustrate how the trust so completely underestimated the passions that the plight
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of our local hospital have aroused. I leave the description of the meeting to Mr. Mike Moss, editor of The Voice, the journal of the Tandridge Voluntary Service Council. He wrote:
"The meeting was held in one of the wards, which, as anyone who knows the hospital could have predicted, was totally unsuitable, being small with glass half walls part way down the ward which effectively acted as baffles to prevent speech being heard. As well as these shortcomings, a microphone system was unavailable. The Chairman attempted to open the meeting but was howled down by those who couldn't hear what she was saying and by others who wished to make their own points.
From that moment on, the 'meeting' degenerated into what could be termed farce if the subject had not been so important. Chaos, disarray, turmoil, confusion—anything short of an actual riot—are just some of the words I use to describe the scene."
It is no wonder that people in East Surrey are, by now, deeply sceptical about the competence of the local NHS management. They are also doubtful about their real motives. The fear in Oxted, especially now that the community hospital has closed, is that the trust, the area health authority, the regional health executive and the Government will take the opportunity to sell the land on which the hospital stands and plough the proceeds into funding the deficit at Redhill. Local concerns on that point are neatly summed up in a letter from my constituent, Mr. I. S. Andrews, who says:
"My very strong personal feeling is that the NHS Trust has been determined to close the hospital come what may having made very little maintenance expenditure over the years. The view taken by many at the aborted meeting was that funds arising from the sale would be used to reduce the indebtedness of the Trust."
I am looking for a categoric assurance from the Minister today that, under no circumstances, will that be allowed to happen. I hope that the Minister will understand the importance of this assurance to my constituents. There have been too many disappointments and too many deadlines missed. Oxted needs a replacement hospital, and the Minister's answer will be studied with great care by thousands of people who feel that their security and quality of life is at risk. Having presided over the closure of the hospital, the Government have a clear duty to ensure that the promises made by the Secretary of State are fulfilled.
In my debate in July 1998 the present Secretary of State said:
"I hope that the hon. Gentleman is reassured by the fact that the implementation plan that is now in place will result in new in-patient, out-patient and therapy facilities, as well as a minor injuries service, being available in Oxted by the summer of 2001."
The summer of 2001 is almost upon us and all we have to show for it is a closed and boarded up hospital. The right hon. Gentleman went on:
"The time scale and detail of the re-provision depend crucially…on the planning decisions taken by Tandridge district council. The local authority will no doubt be mindful of the need for a rapid decision to allay the concerns of local people about the future of health services in the town."—[Official Report, 1 July 1998; Vol. 315, c. 336.]
That last sentence seems like an attempt to shift the burden of responsibility on to Tandridge district council, but before the council can determine a planning application, it must receive it. Tandridge councillors have waited and waited to be given an opportunity to determine a planning application for a new hospital facility in Oxted, but none has been forthcoming. The leader of Tandridge district council, Councillor Gordon

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Keymer, recently again made it clear that he and his administration will do everything possible to expedite any reasonable proposal from the trust, but no planning application has been submitted. Not Tandridge council but the trust is responsible for the delay, and that is the Government's responsibility.
Since our previous debate there has been a further development: the complaint to the ombudsman on behalf of the Save Oxted Hospital action group, headed by Mr. Josh Cosnett, about possible maladministration by the Secretary of State as a result of his decision to order the closure of the hospital for redevelopment. I do not wish to prejudge the outcome of the ombudsman's inquiry, but it is worth placing on record my regret that the result, which was due to be published no later than January 2001, has still not appeared. I hope that the Minister will assure me that that delay has nothing to do with her Department. I am sure that she will make it clear that her Department has co-operated fully, providing timely, accurate and detailed responses where requested, although that has, sadly, not always been the case in correspondence, either with myself or my constituents on that issue.
It is most unwelcome that the decision to close the hospital was taken prior to the outcome of the ombudsman's report. One of the issues raised by the Save Oxted Hospital action group could usefully benefit from an answer from the Minister today. It is suggested that, as a private hospital, Oxted and Limpsfield War Memorial hospital was not subject to the National Health Service Act 1946. It is further stated that, under the terms of its 1939 constitution, the hospital board was required to vote on any change of ownership but that no such vote ever took place. Can the Minister give an assurance today that the NHS has not just closed a hospital to which it had no legal title? It is obviously vital that the issue is cleared up before any further action.
It is no exaggeration to say that, although it had long been feared, the sudden closure of Oxted and Limpsfield War Memorial hospital came as a terrible shock to the whole community. Today it stands empty and boarded up: a tragic emblem of broken promises and a symbol of the failure of the Government's health policies in east Surrey. The Minister has been good enough to reply to written questions on the subject of security but I hope that she will take the opportunity, first, to state that responsibility for the physical security of the building rests with the NHS alone and, secondly, to detail the specific measures that are being taken to protect it from vandalism.
The significance of the hospital's closure and the importance attached to the future provision of replacement facilities in Oxted were evidenced by the huge attendance at a meeting held at Oxted county school on 10 March this year. More than 800 people came to what was probably the largest public gathering ever held in the town. I have already raised many of the questions that were left unanswered at that meeting, but two more remain. Immediately prior to its closure, Oxted and Limpsfield War Memorial hospital held 17 patients. Even if the redevelopment plans go ahead, under the plans there is provision for only 10 NHS beds
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in Oxted. Can that be sufficient? I have asked that question before and have yet to receive a satisfactory reply.
My final question comes from one of the numerous letters that I have received on the subject. My constituent, Mrs. Joyce Spurr, wrote:
"So what next? We were left in doubt as to whether the Trust really does have a nursing home partner at the moment. If they haven't, where does that leave their current plans?"
If the plans fall through, what will the Government do to meet their promise to provide a first-class modern health facility in Oxted?
I conclude by paying tribute to the staff of the hospital, who earned the respect and admiration of the whole community as they continued cheerfully to perform their tasks over a long period of uncertainty and in a building that was gradually falling apart through neglect. I also want to mention the constructive and helpful attitude of the outstanding local general practitioners. They have played a positive role throughout the sorry saga and, despite much provocation, have proved to be a valuable source of informed and level-headed information. I also commend the role played by the respected local community health council, which itself faces an uncertain future under Government plans. Finally, I hope that the Minister will join me in praising the local community of Oxted, which has demonstrated just how much it cares about its hospital. That community now looks for answers and, above all, action from the Minister and the Secretary of State.
1.45 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): I congratulate the hon. Member for East Surrey (Mr. Ainsworth) on securing this afternoon's debate on Oxted and Limpsfield War Memorial hospital. He has raised the topic with my right hon. Friend the Secretary of State for Health and me in correspondence and parliamentary questions during the past few months. He also referred to an Adjournment debate from three years ago. I do not think that anything that I say today will come as a big surprise.
Of course, I acknowledge the strong local feeling about the future of Oxted community hospital and recognise the frustration caused by the time that the development of the new facility has taken. The people of Oxted were promised a new health facility by summer 2001, but it has not materialised. I share the disappointment of the hon. Gentleman and his constituents that progress has not been made as swiftly as anticipated. However, I assure hon. Members that Surrey and Sussex Healthcare NHS trust and East Surrey health authority, supported by the south-east regional office of the NHS executive, are committed to providing new facilities and fully implementing the re-provision of services in their area. The hon. Gentleman asked me for what he called a categoric assurance and I will give him that today—there is no question of any manoeuvring to stop that happening. Unfortunate circumstances have combined to delay progress, but we are fully committed to going ahead.
The hon. Gentleman also referred to the Surrey and Sussex Healthcare NHS trust deficits. If my figures are in any way inaccurate, I will get back to him, but, as I

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have them, the deficits were£5 million for 1999–2000 and £4.4 million for 2001. That deficit must be managed, but meeting it by raising money from land sales is in no way part of the plan. The plan is to provide the services at Oxted and Limpsfield War Memorial hospital.
Mr. Peter Ainsworth: I am grateful for that reassurance. Will the Minister be courageous enough today to offer a new deadline for the completion of the provision?
Ms Stuart: I hope that, as I continue, the hon. Gentleman will understand why making such an offer would be a brave decision, as civil servants would describe it, and why it might not be possible to be so precise.
The hon. Gentleman will also note that the Government have set a challenging agenda for the NHS, one which will turn the NHS of old into a truly modern service. The NHS plan, which was published in July last year, set out the most fundamental and far-reaching programme of reform in its history. That 10-year plan aims to improve every aspect of the NHS—a reliable service that provides effective health care services and has patients' interests at its heart.
For the current financial year 2001–02, East Surrey health authority received nearly £290 million, which represents a 50 per cent. cash increase on the allocation of three years ago. The Surrey and Sussex Healthcare NHS trust has also benefited from specific capital investments—£200,000 to modernise the accident and emergency department, which was completed in March 2001, £700,000 to provide a major extension to the day surgery unit, and £150,000 to re-provide the child development centre. It is not that we do not believe in community hospitals. The Government are committed to making appropriate and effective use of such hospitals. We recognise the strength of feeling that people have for their local community hospitals and the value of those hospitals as part of the community that they serve.
The NHS plan announced that£900 million would be made available annually by 2003–04 for new intermediate care and related services to promote independence and improve quality of care for older people, of which around £255 million is to be earmarked specifically for NHS investment in intermediate care. We also pledged that, by 2004, there would be 5,000 extra intermediate care beds. Some of those will undoubtedly be in community hospitals, some in existing facilities and some in new developments.
I remind the House of the context for the changes in health services at the Oxted and Limpsfield community hospital. The re-provision of services at that hospital was consulted on, as the hon. Gentleman already knows, by East Surrey health authority during March 1997. The main drivers for that change were that the buildings were in a poor state of repair and suffering from subsidence. It was more cost effective and more appropriate for modern health care to look at building alternative facilities in Oxted rather than to attempt to upgrade the building.
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The hon. Gentleman also referred to some of the issues raised in relation to the ownership of the hospital. The advice that the Department of Health received from the legal advisers was that Oxted hospital was transferred under the National Health Service Act 1946 and section 6(1) of that Act provides that voluntary hospitals shall be transferred to, and vested in, Ministers on the appointed day—the day the Act came into force in 1948. The interests in the property, where held by a governing body or by trustees, would pass to the Ministers free of any trusts. Furthermore, the re-provision of an in-patient facility as an out-patient facility is within the Secretary of State's functions and in keeping with the objects for which the property was used immediately before 1948. We are acting on the best legal advice, although I will not go into the finer points. The models of health care were changing and I am sure that the hon. Gentleman is aware that, as part of the original consultation, the number of beds was increased in the final plan from six to 10.
The proposed plans for Oxted reflected advice on safe medical practice and the changing nature of health care. They ensure that appropriate services, such as out-patients, therapies and nursing home beds, remain locally based and that more acute in-patient services shift to acute hospitals. The outcome of the consultation resulted in a decision to provide a new hospital to be built on land next to the existing hospital site. That will provide the same range of out-patient, diagnostic and therapy services as is currently available, but with the advantage of purpose-built modern accommodation. Furthermore, 10 in-patient beds are to be purchased from a private nursing home provider in the local community.
For a number of reasons, between 1997 and late 1998, the progress with developing a new scheme was relatively slow, as a number of local issues had to be debated and resolved before detailed work could begin. Those included the need to agree land development issues with the local council as well as agreeing the most appropriate option to deliver the preferred health care facilities. At the time of the last Adjournment debate, the anticipated time scale for completion of the project was July 2001. Although there had been some progress towards that target, a number of factors have meant that the project has suffered further delays.
An outline business case was approved at the end of 1999, a preferred bidder has been selected and negotiations have been under way with that private sector provider for some time. Notwithstanding the ombudsman's investigation, which I shall address in a moment, the trust is seeking to ensure that its proposed new build scheme represents best value for money to the NHS, and thereby the taxpayer.
As the hon. Gentleman stated, the trust recently had to close Oxted community hospital. That was partly due to the recent severe and prolonged rainfall. The fabric of the old hospital building has suffered a sudden and marked deterioration to such an extent that a safe environment for staff and patients could no longer be ensured. Representatives from the south-east regional office of the NHS executive visited the hospital on 6 February 2001 to ascertain the state of the building. Reports were received that examined in detail the building conditions, the impact on health and safety and

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other important issues such as infection control. An independent health and safety report commissioned by the trust alone concluded:
"If the hospital remains open in its current condition, it will constitute an immediate and continually rising risk to staff, visitors and patients' health, safety and welfare."
It is fair to say that the building was not in the best condition before the recent spell of had weather, but the trust would strongly disagree with any suggestion that it was due to negligence on its part. In cases where the provision of a new health care facility has already been agreed, a balance will inevitably have to be struck between committing resources to the further upkeep of the old building and funding the provision of health care services.
I am aware that, at a public meeting chaired by the hon. Gentleman, the trust declared its intention to close the hospital, and restated the commitment of both the health authority and the trust to deliver new health care facilities as soon as possible. Following closure, the trust and the health authority were able to take immediate steps to ensure that local health services were sustained. The majority of in-patients at the time of closure were either discharged or relocated to social services long-term care, a neighbouring community hospital or to the local acute hospital.
Out-patient services were relocated to spare capacity within the Oxted GP surgery and I am advised that it is working well. Any patients subsequently requiring care are referred to a local nursing home, the neighbouring community hospital or, if they require closer supervision, East Surrey hospital.
The hon. Gentleman referred to the ombudsman, who is investigating a complaint against the south-east regional office. It relates to the administration of the consultation process about the re-provision of services at Oxted hospital back in 1997. The complaint was formally notified to the then Permanent Secretary on 12 June 2000, and the inquiry has subsequently been in progress. I am advised that the NHS executive has complied fully with all the ombudsman's requests for information and will continue to co-operate fully.
The ombudsman has yet to report his findings. The hon. Gentleman will appreciate that, because of the substance of this complaint, the trust will have to await the outcome of the investigation before proceeding with the permanent closure of the hospital and the provision of new facilities. It is inappropriate for me to comment further, pending the outcome of the investigation.
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There is, of course, a need to respect the memory and history of the old War Memorial hospital and I would not wish to diminish its importance. The artefacts of memorabilia have already been secured from the closed buildings and safely removed to the care of local GPs. The trust will continue to work with GPs and the local community to establish the best way to make this memorabilia safe in the long term and to ensure that it is accessible to local residents.
The hon. Gentleman also inquired about the physical security of the building. Following consultation with the local police and crime prevention officer, I can assure him that measures to ensure the external and internal security of the building have been taken. I understand that a representative of the trust will be meeting the crime prevention officer tomorrow at the old hospital to confirm that the measures taken are satisfactory. In addition, rubble will be installed in the driveway on Thursday to prevent vehicles being taken on to the site, which has also been insured against fire risks.
I recognise that the hon. Gentleman and his constituents are frustrated by the length of time that it is taking to develop a new facility. He will not be surprised to hear that I share some of that frustration, but I should like to reassure him and his constituents that that all parties are working together to ensure that the new health care facilities are provided as swiftly as possible. The hon. Gentleman will appreciate, however, that no contractual arrangements can be entered into or commitments given to a private sector provider until the outcome of the investigation by the ombudsman is known.
In the meantime, we are ensuring that the necessary frameworks are in place to allow us to make progress, once the investigation is over, as quickly as possible. I have instructed the regional office to monitor the position closely and to report developments regularly. Once the ombudsman has reported, I would welcome the opportunity to discuss subsequent steps with the hon. Gentleman. When the decision has been taken, it is crucial to move forward as quickly as possible. I hope that we can bring this unhappy tale to a conclusion that will, although late in the day, both allow new hospital provision and retain the memory of the War Memorial hospital. In the end, we want to serve the hon. Gentleman's constituents and all patients as best we can, and that is a shared objective.
Question put and agreed to.
Adjourned accordingly at one minute to Two o'clock.