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On Monday night, the nation had the opportunity to witness the professional and competent response of the ambulance service to the emergency caused by the pile-up on the M25, when six crews, who have not been paid since October, responded to an emergency call to treat victims of acute injuries. Few hon. Members could look on those injuries, far less know how to begin to rescue the victims. Those crews know that they are an emergency service, and they are mystified and wounded that the Health Service is in the hands of a Secretary of State who tries to deny it.

There is another issue in contention which is perfectly expressed in the letter to Miss Mitchell : whether those ambulance crews are skilled personnel or professional drivers. I understand that the Secretary of State is sensitive on that point. He has accused COHSE of doing a scissors and paste job on his letter. Therefore, to avoid any doubt, I shall read the full paragraph. In context, the statement reads no better than it does out of context. Frankly, in the context of a letter to a 15-year-old girl about her father, it reads decidedly worse than when it is taken out of context.

The letter states :

"The vast majority"--

I ask the House to remember those words--

"of ambulance staff have had no extended paramedical training at all. They are professional drivers, a worthwhile job--but not an exceptional one."

It is clear beyond reasonable doubt from the context that the Secretary of State is describing the vast majority of qualified ambulance staff as professional drivers. Four out of five ambulance staff are fully qualified. That means that they are trained in life-saving skills, can treat head injuries and those with spinal injuries and open wounds. All the fully qualified ambulance staff are trained in resuscitation and the suction of blockages. All of them are capable of carrying out childbirths in emergencies. In their career many ambulance staff have carried out more than 50 births at the kerbside. They are all trained in handling and lifting people with serious fractures. Many of them put themselves at risk in providing those services to accident victims.

The ambulance personnel who responded to the pile-up on the M25 drove through the same thick fog that caused that pile-up and attended the victims in that thick fog. Those ambulance staff who attended some Conservative Members in the Grand hotel did so while one floor of it collapsed.

Increasingly, those ambulance staff are being assaulted by those they come to serve. I have here a letter sent by an ambulance man in Barnsley. It states :

"I have had my spectacles smashed on two occasions I have been kicked and abused and, on one occasion, threatened with a shotgun Who is more at risk these days than the ambulanceman from contracting A.I.D.S., or Hepatitis B We don't stop to ask the injured and dying patient if he is suffering with these diseases--we just get on with doing what has to be done."

That is the job that the Secretary of State describes as "worthwhile" but "not exceptional". What professinal driver needs those skills, takes those risks and undergoes that stress? The Secretary of State and his Department know about the stress on ambulance drivers. Seven years ago it received a report on stress among ambulance workers. It was a report in the context of a study on whether ambulance staff should be allowed to retire earlier than at 65 years of age. That study found that few made it to the retirement age of 65. Most took early retirement, frequently through ill health. Of the few who made it to 65,

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the average period of survival in retirement was 2.4 years. We are haggling over a pay award to a group of workers whose mortality rate is one quarter higher than the average for industrial workers. In the negotiations, to quote the Secretary of State's letter to Miss Mitchell, we are told

"the union side has not budged an inch."

Since the dispute began, the staff side has dropped its demands for enhanced payments for overtime, standby payments to staff on call, an increment for long service and a reduction in working hours. The only two elements that remain are for a higher pay award this year--and staff are willing to compromise on the amount--and for a pay mechanism for future years--and staff are willing to compromise on the formula. The Secretary of State persists in claiming that the staff side is claiming 11.4 per cent. He knows perfectly well that a long time ago the union side said that it was willing to negotiate that figure. One has only to read his correspondence. On 3 January he received a letter from Mr. Roger Poole which said :

"In your recent television and radio interviews you say we are unwilling to move from the 11.4 per cent. claim. We have stated both publicly and privately that we are willing to enter into serious negotiations with you and, if necessary, lower our sights." For what it is worth, I shall tell the Secretary of State what, in my judgment, would secure a negotiated settlement. I believe that, if he were to split the difference between his position and that of the ambulance staff, he would obtain a settlement in the first hour. It would cost him £5 million--less than half the increase in his advertising budget for the current year for the Department of Health.

It is clear that the Secretary of State will not succeed in making the ambulance staff settle for 6.5 per cent. even if he tries to disguise it as 9 per cent. over 18 months. The ambulance staff are perfectly capable of spotting that that is 6 per cent. over 12 months. Any doubt about their capacity to spot it was resolved by the negotiations with the Association of Professional Ambulance Personnel.

The House will remember that the Secretary of State discovered the association in late November as a new authentic force representing ambulance staff. He gave it negotiating rights that it had never had before, hoping that it might accept the offer that the other unions had rejected. Unfortunately for the Secretary of State, the members of the association threw out his offer by a majority of 2 : 1. Moreover, that was a majority of the rump of the members, after half the membership had resigned in disgust at the negotiations being held.

Since November 1989, I am sorry to say that I have been unable to trace any reference by the Secretary of State to the Association of Professional Ambulance Personnel. Nor has he repeated any of the words of praise that he heaped upon it before the ballot took place. The reason why the Secretary of State could not sell 9 per cent. to the Association of Professional Ambulance Personnel over 18 months or 6 per cent. over 12 months to the other ambulance staff is that the ambulance staff can see that no one else is buying 6.5 per cent. Income Data Service provides a monthly analysis of recent pay settlements. Its analysis of the most recent 83 settlements between November 1989 and February 1990 shows that 72 were struck at over 7 per cent., 56 were struck at over 8 per cent. and 18 were struck at over 9 per cent.

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One of those 18 is the pay award to ourselves. At the end of this month, hon. Members will receive a 10.6 per cent. increase in their salaries. We receive that increase because the same increase has already been granted to the principal grade in the Civil Service. I do not see any reason why hon. Members should be ashamed of seeking parity with the principal grade in the Civil Service. For that reason, I voted for the mechanism when the House debated it in 1987. What is more to the point, the Secretary of State for Health voted for that mechanism and so did the Minister of State and the Parliamentary Under- Secretary of State.

I believe that we voted the right way in 1987. It was correct for the House to seek a pay mechanism to settle its pay in future years. Having established that mechanism for themselves, I wonder how they dare table an amendment in the House describing such a pay mechanism for ambulance staff as highly inflationary.

Whenever I turn on the television or radio in the morning, the first thing that I hear is the Secretary of State telling me that he cannot intervene in the ambulance dispute because the management of the Health Service must resolve the issue. May I tell him the views of the management of the ambulance service, as far as they are known? A survey has been carried out, not by the Labour party, or any of the newspapers to which we are affiliated, but by the Financial Times. It found that, of 45 chief ambulance officers, 40 wanted a payment mechanism for settling pay within the ambulance service.

What is stopping them from striking a deal that 40 out of 45 ambulance officers want? The article gives the reason. It quotes Mr. Tom Crosby speaking with characteristic frankness. He says : "it goes right against the grain of Government policy," There we have it from one of the most senior managers of the ambulance service in Britain. The reason why a pay mechanism formula is off limits is not because the management of the Health Service do not want it but because it goes against the grain of Government policy. Responsibility for that policy rests with the Secretary of State.

Mr. Tim Devlin (Stockton, South) : Will the hon. Gentleman tell the House whether, if he were in the Secretary of State's position, he would accept the pay mechanism originally proposed by the ambulance men and their full claim?

Mr. Cook : I am disappointed in the hon. Gentleman. I know that he attends our debates on health. I regret that I could not give way to him in the previous debate. I am sure that he was present during the emergency debate in November. That very same question was put to me by the Secretary of State, and I am sure that the Secretary of State has not forgotten it. My answer then, which has not changed, was that I accept that in the present circumstances the negotiations should include negotiation on a pay mechanism for the future. The hon. Gentleman should stop looking at the notes that are being passed to him to pass to the Secretary of State and listen to what I have to say. I have never said that we would go snap on the ambulance unions' demand for linkage to fifth-year firemen. Nor has the union side said that it would stick out for that and that alone, as the hon. Member for Harlow is

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aware. It has made it clear that it is willing to enter into meaningful negotiations. However, it has said that a pay mechanism must be part of the settlement.

After four months of the dispute, the public would regard it as perplexing if we were to settle last year's pay settlement only two months before the start of negotiations for next year's settlement, without any idea how that pay is to be determined.

I now turn to what has been the most dramatic feature of the dispute.

Mr. Nigel Spearing (Newham, South) : Will my hon. Friend give way before he deals with that point?

Mr. Cook : I shall give way on this occasion, but I am conscious of Mr. Speaker's instruction and I am anxious to move to a close so that other hon. Members can speak, so this must be the last intervention.

Mr. Spearing : I am grateful to my hon. Friend. Does he recall that in the late-night debate on 20 December, when the Secretary of State, despite the dispute, reneged on his responsibilities and did not appear, the Under-Secretary of State for Health, who is now here, admitted, in reply to my speech, that the funding of the ambulance service should not be demand-led, that it must have cash limits, and, therefore, the pay policy to which my hon. Friend has referred was automatically cutting into the other services? Is that not something with which nobody in the House or in the country can agree, because surely an ambulance service and an emergency service must be demand-led in order to keep the staff going?

Mr. Cook : Whether hon. Members agree with those statements that my hon. Friend correctly quoted from the Under-Secretary of State, it must be self-evident to hon. Members on both sides of the Chamber that those propositions are not of the making of Duncan Nichol ; those limits are of the making of Ministers in charge of the Department, who must accept responsibility for the consequences. My hon. Friend leads me on to my concluding point. I also recall that the Under-Secretary of State said in his speech that he was aware from his own constituency experience--I do not think that I misrepresent him--of the powerful public support for the ambulance service. That is the most dramatic feature of the dispute. The degree of public support in this dispute is without precedent both in its sheer scale and in the length of time for which it has been sustained.

Consistently, the ambulance staff have been beating the Secretary of State in the opinion polls by majorities of 8 : 1. On the "Newsnight" poll, when asked whether their sympathies lay mainly with the ambulance staff or with the Government, 65 per cent. of Conservative voters sided with the ambulance staff, leaving only 19 per cent. to side with the Government. That is the sort of margin that the Prime Minister will no doubt claim as a triumph if she is re-elected next year by the 1922 Committee. The Secretary of State can write off the Labour voters, he can ignore the centre voters, but I ask him at least to accept the verdict of his own supporters. Nor are those just idle responses to pollsters who have caught the public in the right mood. The public out there are backing their vote in the opinion polls with their money. One reason why the Secretary of State will not starve the ambulance workers back to work is that the

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public will not let him. I visited Waterloo ambulance station yesterday and I was told that the day before, Tuesday, it received the largest collection it had ever received in donations since the start of the dispute. The public continue to give their support as generously as the ambulance staff give their commitment.

There is, though, one measure available in this building to hon. Members by which they can measure the degree of public support. They can even feel that degree of public support. It is contained in the 100 boxes in the vaults of the Journal Office which contain the petition that my right hon. Friend the leader of the Labour party received from the ambulance staff and which I presented in the Chamber in the week before Christmas. That petition contains 4.5 million signatures, more than the combined majorities of all Conservative Members. It is the biggest petition ever presented to Parliament in our history.

Every schoolchild is taught that one of our liberties is the right to lobby and petition Parliament. The public have exercised that liberty on an historic scale in this case. No Parliament can persist in ignoring an expression of public opinion on that scale without bringing itself into disrepute. No Government in eastern Europe would ignore such an expression of the people's will.

I hope that the Secretary of State, who is about to take the Floor, will not treat us to another of his lectures that the public do not understand the issue ; that the public are taken in by the propaganda and hairstyle of Roger Poole. The country is weary of the Secretary of State's homilies, of the idea that he knows better than all the rest of us and that he will take on all 4.5 million petitioners. Democracy turns on a belief that, upon occasion, the public are right and the Government wrong. This is one of those occasions. The public are right to insist that the ambulance staff deserve a fair and just reward and that patients and public deserve a pay mechanism so that never again will this emergency service be exposed to disruption.

The vote tonight is not between the Government and the ambulance staff ; it is a vote between the Government and the public that they are ignoring. I appeal to Conservative Members to join us in making this a debate that not even the Government can ignore.

5.5 pm

The Secretary of State for Health (Mr. Kenneth Clarke) : I beg to move, to leave out from "House " to the end of the Question and to add instead thereof :

"recognises the important contribution made by the skilled and dedicated service of ambulance staff ; regrets that some have seen fit to take action against patients in furtherance of a pay dispute ; appreciates the work of the police and Army in maintaining an adequate emergency service ; supports the Secretary of State for Health and the National Health Service Chief Executive on their handling of the dispute ; and urges them not to give way to demands for a higher inflationary pay settlement or any formula or other arrangement that would automatically trigger future pay increases which could only have an adverse effect on patient services." I suppose that I should be grateful to the hon. Member for Livingston (Mr. Cook) for what turns out to be a helpful rope that he is passing to me with the motion. Having listened to him, I am not altogether convinced that that was his principal motive. I think that he tabled the motion rapidly, or announced his intention of doing so rapidly, after a flurry of press reporting.

I have no recollection of any occasion when a debate on the Floor of the House of Commons has speeded up the

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resolution of an industrial dispute, and I do not think that that was the hon. Gentleman's prime motive either. Nevertheless, it gives me a valuable opportunity to explain to hon. Members exactly where I think we are now and, most importantly, where we shall be going in order to resolve the dispute which, obviously, no hon. Member wants to continue or ever wanted to start.

The hon. Gentleman referred to a difficulty. I have seen many difficulties in health policies during the years that I have been in the House of Commons. In my recollection, every Secretary of State for Health, in all three Governments that I have seen, has been a controversial figure in a controversial service. I take no objection to that. I do not think that I have set a new record yet, as I have clear recollections of Barbara Castle, but I may be on the way. I knew that when I took on the task.

I also believe that if a Secretary of State takes on the process of reforming the NHS, he is likely to make himself an even more controversial figure, because this is a giant service and in every giant organisation any process of change causes understandable uncertainties, sometimes fears, and even anger.

Mr. Geoffrey Robinson (Coventry, North-West) : Will the right hon. and learned Gentleman give way?

Mr. Clarke : No. I shall not give way at this point.

I have always told those outside and those in the House, friends and opponents alike, to look at my actions and to realise that I base my actions, decisions, policies and statements on the NHS on a passionate, personal commitment to that service. It is my determination to make sure that during my period of office the NHS is made a better service for its staff and its patients.

A better NHS requires an even better ambulance service than we have at the moment, and that thought has not just occurred to me during the industrial dispute. Over the years, we have not paid enough attention to the ambulance service inside the NHS. A higher proportion of its staff need extended training that gives the life-saving, paramedical skills to those who are required to deliver the accident and emergency services, and those better- trained staff need to be spread more evenly throughout the country.

We also need to develop a service that concentrates increasingly on the tasks that a Health Service ambulance service is required to perform. Once I have dealt with the short-term points made by the hon. Member for Livingston, I shall touch on the future of the service and relate that to the key problem of the current dispute and how it is to be resolved.

Mr. Geoffrey Robinson : Will the right hon. and learned Gentleman give way now?

Mr. Clarke : No, I shall not give way at this time.

Mr. Robert Hughes (Aberdeen, North) rose --

Mr. Deputy Speaker (Mr. Harold Walker) : Order. Obviously, the Secretary of State does not wish to give way at this point.

Mr. Clarke : I shall give way, as I always do in this House--but at an appropriate stage, when I have dealt with the substance of the dispute.

I shall deal first with the points made by the hon. Member for Livingston concerning the handling of the dispute and the remarks that I was alleged to have made

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about ambulance men. There is a particular difficulty in respect of public sector disputes. In every industrial dispute--I have been engaged in several--its reporting in the press and by the other media, and debates in this House, are ultimately never the arena in which the dispute is resolved. The private sector has the advantage that day by day publicity and media events do not play a significant part in its disputes in the way that they do in protracted public sector disputes.

Throughout the ambulance dispute, I have sought to make three key points. I shall make them again in this debate, and enlarge upon them. They are the only points that I can helpfully make to the general public in the day-to- day exchanges. First, the claim is excessive and not justified by comparison with other Health Service staff who have not taken industrial action. Secondly, the management's offer is fair and generous, and it should be accepted. Thirdly, the industrial action organised and taken by the trade unions concerned is against patients and patient services, and it cannot be justified--as industrial action in any essential service cannot be justified. For four months, I have stuck to those points fairly doggedly, while also paying tribute to the caring nature of the work done by ambulance staff and the service itself.

It is inevitable that my message has not always proved popular. It is not possible to represent the case of the Health Service and of the employers against a group of people who are held in such high public respect as are ambulance staff, who can produce a popular message. It is not possible to produce stories day by day of the kind required by the newspapers and the other media in doing their job and make them popular. Those who present the ambulance service claim, who describe in moving terms its work, and who appeal to the public on behalf of what we all know to be an extremely popular group of people can always be appealing--not least in the run-up to Christmas--[ Hon. Members :-- "Shame."]

Mr. Geoffrey Robinson rose --

Ms. Joan Ruddock (Lewisham, Deptford) rose --

Mr. Deputy Speaker : Order. The hon. Member for Livingston (Mr. Cook) was given a very fair hearing, and the Secretary of State is equally entitled to a fair hearing. Constant barracking does little to maintain the reputation of this House.

Several Hon. Members rose --

Mr. Deputy Speaker : Order. I shall remain on my feet for as long as is necessary to allow the Secretary of State to receive a fair hearing.

Mr. Spearing : On a point of order, Mr. Deputy Speaker. You will recall that, in the hearing of the House, the Secretary of State gave an assurance that he would give way at an appropriate point in his speech. The right hon. and learned Gentleman made three specific assertions, as he had every right to do, concerning the dispute. At that appropriate point, my hon. Friend the Member for Lewisham, Deptford (Ms. Ruddock) rose in her place in the hope that the Secretary of State would give way. Is it conducive to good order in this House if a right hon. or

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hon. Member, having indicated that he will give way at an appropriate moment, refuses to do so when it is reached? Is that not against the traditions of this House?

Mr. Deputy Speaker : That is not a matter for the Chair. I remind the hon. Member for Newham, South (Mr. Spearing) that other right hon. and hon. Members will have an opportunity to participate in the debate.

Mr. Clarke : I am attempting to dispose as quickly as possible of the aspect known as the handling of the dispute. I want then to move on to the reality of the dispute, the present position, and what the dispute is all about. I do not wish to give way at this point. I believe that I have disposed of the handling of the dispute, save for that matter upon which the hon. Member for Livingston chose to dwell. He referred to the incident that was the only reason why he tabled the motion--my alleged insult to ambulance men in an extract clipped from a letter sent to one of my constituents. It is within the recollection of the whole House that that incident was the sole reason why the hon. Member for Livingston leapt in and decided to debate the ambulance dispute.

Mr. Neil Kinnock (Islwyn) : On a point of order, Mr. Deputy Speaker. The motion on the Order Paper is in my name, as it is appropriate that it should be in the name of the Leader of the Opposition. I took the decision to table a motion on the conduct of the ambulance dispute and expressed a desire to achieve a speedy and satisfactory solution to that dispute many days before Christmas. It is the privilege of the Opposition not to disclose the precise terms of an Opposition Day debate much before the day itself. I ask the Secretary of State to withdraw completely everything that he just said.

Mr. Clarke : I shall answer that statesmanlike intervention, but I shall not withdraw my remarks. I am relying on the public utterances of the hon. Member for Livingston in making my comments. I believe that the motion was tabled without any consultation with the ambulance staff trade unions and that no one directly concerned with the dispute is of the opinion that the right hon. Gentleman's decision to table it has done anything to speed the resolution of the dispute. A debate on the Floor of the House certainly cannot do so. I continue to believe that that was not the Opposition's prime motive, but I shall move on.

Mr. Kinnock : Further to that point of order, Mr. Deputy Speaker. I do not want to delay the debate, but the Secretary of State made a direct allegation that was entirely misplaced. Naturally, I hoped--as I presume all right hon. and hon. Members did--that the dispute would have been resolved well before today. However, as my right hon. and hon. Friends know, the decision to use this day to debate the dispute if it had not been resolved was taken well before Christmas. I simply ask the right hon. and learned Gentleman to withdraw his remarks, because he is unnecessarily diverting this House and public opinion.

Mr. Clarke : Of course I accept the right hon. Gentleman's word, although he also confirmed that the final decision to proceed today was taken--as it must have been--last week. I am relying on the public utterances of the hon. Member for Livingston.

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I am glad that the right hon. Member for Islwyn (Mr. Kinnock) is here, because the one further point concerning the handling or conduct of the dispute with which I wish to deal, before I come to the substance of my argument and give way to those hon. Members who have been rising, is the alleged insult that I am meant to have made against ambulance men--last week or at any other time. I make it clear that my views about the ambulance service and the men and women who work for it are identical to those of the general public. I do not know anybody who does not hold the ambulance service and its work in very high regard--[ Hon. Members :-- "You!"]

The arguments of those who support the ambulance men are sometimes based on the proposition that, if one has respect for the work that the ambulance service does--I expressed that respect repeatedly in my letter to my constituent--it follows that one should settle their pay claim at whatever level those who represent them persist in claiming in an industrial dispute --[ Hon. Members :-- "No!"] I am delighted to hear that denied.

It has been a feature of the dispute throughout that those conducting it on behalf of the ambulance men have sought to allege that their action has been provoked in some way, either by a member of the Government or by one of the Government's supporters. Before my letter to my constituent was used, in an amazingly edited form--four words of an extremely long letter-- a campaign had been in progress for about a fortnight against my hon. Friend the Minister for Health, who was being accused of making provocative remarks to ambulance men in her area. [ Hon. Members :-- "Oh, what a shame."] My hon. Friend's reputation did not allow that allegation to be sustained. Moreover, I understand that my hon. Friend the Member for Maidstone (Miss Widdecombe) is now being accused of having provoked the strike in Kent by her remarks on the "Kilroy!" programme yesterday. This is all ridiculous.

I repeat that I hold the work of the ambulance workers in very high regard. Of course we all applaud their emergency work and we admire the caring nature of the rest of their work. Nothing in my letter contradicts that. Having said that, it is a fact that is relevant in evaluating the ambulance men's claim that, as far as anyone can judge, about one in 10 of the patients whom they carry are accident and emergency patients. That does not just mean "999" patients. In the National Health Service, emergency patients include people who are seriously ill being moved straight to hospital on the advice of a doctor.

The flurry and excitement in the Box during the speech of the hon. Member for Livingston arose when officials went to look for a photostat of the page from the Clegg report from which the one-in-10 figure was extracted. I remind the House that the Clegg commission was set up by the previous Labour Government. Of course, the proportion varies from place to place. More up-to-date figures are available from York health authority. Each year an annual digest of ambulance figures appears, and one might have thought that the hon. Member for Livingston would have consulted it concerning the current figures. The digest shows that, over the country as a whole, about one in 10 patients carried are accident or emergency cases.

Mr. Rhodri Morgan (Cardiff, West) : Will the Secretary of State give way?

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Mr. Clarke : All right. I shall give way on that point.

Mr. Morgan : The Secretary of State will appreciate that the pay of Members of Parliament is based on an automatic formula, although he would probably say that 80 per cent. of us are only professional debaters--[ Hon. Members-- :"We are."] Conservative Members can speak for themselves. The right hon. and learned Gentleman would probably say that for 80 per cent. of her time the Prime Minister is merely a professional ambulance chaser, yet her pay too is calculated on an automatic formula. What about giving the ambulance men an automatic formula to take them out of the political arena?

Mr. Clarke : The hon. Gentleman may have an automatic formula, but I do not and nor does the Prime Minister.

Hon. Members : Yes, she does.

Mr. Denis Howell (Birmingham, Small Heath) : Will the right hon. and learned Gentleman give way?

Mr. Clarke : No. I do not think that the point made by the hon. Member for Cardiff, West (Mr. Morgan) has the slightest serious relevance to the debate, although, incidentally the pay rise that I am to receive this year is 4.7 per cent.

If the hon. Member for Cardiff, West is worried about the amount that he is to receive following the resolution of the House, he is welcome to give the surplus to a medical charity of his own naming. Several Hon. Members rose - -

Mr. Clarke : I shall give way a few times but I would ask hon. Members to intervene on serious points, and as I make progress.

Mr. D. N. Campbell-Savours (Workington) : Will the right hon. and learned Gentleman give way?

Mr. Clarke : Certainly not. There are some hon. Members to whom I will not give way at any stage during my speech.

Mr. Campbell-Savours : Oh!

Mr. Clarke : When wounds have healed, perhaps, but not at the moment. I should hate to be responsible for the hon. Gentleman being named in the Chamber after what happened in Committee.

It is also extremely relevant that only just over one in 10 of the ambulance staff have full extended paramedical training that we have described. There is a clear distinction, as everyone in the service knows, between that training and the six weeks' training which the trained ambulance man undergoes and to which the hon. Member for Livingston referred.

Sir Cyril Smith (Rochdale) : Will the Secretary of State give way?

Mr. Clarke : The whole point of my letter to my constituent--[ Hon. Members :-- "Give way!"] I shall give way in a second, when I have finished this point.

The whole point of my letter to my constituent--and it is an extremely important point in the dispute and the discussions--is that, in my opinion, the proportion of people with extended paramedical training should be increased. More important, that view is shared by the

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management of the service and Duncan Nichol's offer has been based on a widening of the differential between the paramedics and the rest and on the aim of moving to a service in which we train many more people. It is a disgrace, for example, that there are only eight in London.

Sir Cyril Smith : Will the Secretary of State give way?

Mr. Clarke : I shall give way to the hon. Gentleman. I am sure that he is a welcome sight to ambulance men when on his feet if not when prone.

Sir Cyril Smith : Does the Secretary of State agree that paramedics have four skills over and above the skills of other trained ambulance personnel? The Secretary of State says that he is keen to ensure a more highly trained and better-qualified service. One of the four extra skills that the paramedics have is in the use of

defibrillators. Can he explain why the necessary equipment is not provided by the state and is not part of the equipment of any standard ambulance? If he is so keen on a more highly qualified service, why does he not give the ambulance men the equipment and training, rather than merely words from the Dispatch Box?

Mr. Clarke : That is a valid point ; I think that we should. I shall check the facts and write to the hon. Gentleman, but I do not think that he is correct in believing that such equipment is not available anywhere. Let us be clear what we are talking about. Extended training to the full standard takes two months' full-time study and includes training in infusion, intubation, defibrillation and the administration of drugs. It is certainly right that we need more people who can do those things and that we need fully equipped ambulances-- [Interruption.]

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