§ 25. Mr. Viggers
To ask the Secretary of State for Health what changes are planned for the greater use of local hospitals in the diagnosis and treatment of accident and emergency cases. 
§ Mr. Hutton
Changes to services are the responsibility of the local NHS. New guidance on service change, Keeping the NHS Local—A New Direction of Travel, was published on 14 February 2003. It sets out core principles for service change that the NHS must now follow. It challenges the view that biggest is best, and sets out a range of strategies and options to help the NHS keep services local.
§ Chris Grayling
To ask the Secretary of State for Health what assessment the Avon Ambulance trust has made of delays at accident and emergency departments since the Commission for Health Improvement Report in October 2002; what conclusions that assessment reached; and if he will place a copy of the assessment in the Library. 
§ Ms Blears
Avon Ambulance service national health service trust advises that it has refined its monitoring and reporting procedures to assess the causes and impact of delays in the transfer of care at local hospital accident and emergency departments. Working in close collaboration with the new emergency care networks, a number of improvements are now being implemented locally. Further information about the assessment can be obtained from the trust chief executive.