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the assumption that we have a better ambulance service with more paramedics. We all know that the ambulance service is deteriorating. It is predicated on the assumption that we have minor injuries units. None is in place yet.

It is predicated on the assumption that there is a better transport infrastructure for access to Harold Wood. There has not been even an application for planning permission. It is predicated on the assumption that there are sufficient beds in the remaining hospitals to take up the closure of Oldchurch A and E. We know that Harold Wood does not even have enough beds simply to cope with the demands from the A and E department.

No other health authority is attempting to serve the needs of a community of 400,000 people from one site only. That is what North Thames regional health authority proposes to do. It is our view that if the proposals were accepted by the Secretary of State, up to 40, 000 accident and emergency patients would have nowhere to go and that those patients would be at the bottom of the pile.

11.59 pm

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : I congratulate my hon. Friend the Member for Romford (Sir M. Neubert) on raising this matter, which is clearly of great interest to his constituents and is clearly causing them a great deal of concern. He and the hon. Members for Barking (Ms Hodge) and for Dagenham (Ms Church) have pointed out that these are proposals and that they have been made by the local trust.

I am able to say only a limited amount at this stage. I have listened carefully to what has been said. I am aware that reviews have been undertaken into services in the two hospitals and that the trust has undertaken an evaluation. The conclusion of the trust's review was that both Harold Wood and Oldchurch hospitals would be required for the foreseeable future, but that action and emergency services should be located at Harold Wood. The health authority has arrived at a broadly similar conclusion.

I should like to make some general observations about the provision of accident and emergency services. Obviously, it is vital that all people living in the area should have access to the best A and E services available. We should be looking for first-class services, supported by the necessary back-up. They should deal with the full range of injuries and illnesses at any time, day or night, and should be flexible enough to deal with the characteristic peaks and troughs.

To perform to that high standard, major accident and emergency departments need direct access to a wide range of acute specialty and support services on the same hospital site. Many health service districts have concentrated their A and E services on one site to achieve that. That is in line with the National Audit Office report on A and E which was highly critical of "split site" arrangements and said that they

"jeopardised the treatment of patients."

The 1992 report of the national confidential inquiry into perioperative deaths concluded :

"The problems caused by the requirement for consultants (and their teams) to work and be on call regularly on more than one NHS site are well known. The use of split sites should be historical." The message, therefore, is that the best accident and

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emergency services come from larger departments. Research shows that the incidence of preventable deaths is reduced by concentrating highly experienced medical and nursing staff on one location. As my hon. Friend the Member for Romford said, the community health council has apparently accepted the argument for one site and there seems to be--I hesitate to say this, but I think that it is right--a measure of agreement that accident and emergency facilities in the area should be rationalised at one site. Evidently, considerable disagreement exists about which site that should be. A number of arguments exist for rationalising at the Oldchurch site and a number for rationalising at the Harold Wood site. Among the arguments for Oldchurch would be better access for Dagenham and Barking residents, who are the major users of emergency services. It might be said that the accident and emergency service should be located nearer those residents because of the relative deprivation and the problems of the somewhat underdeveloped primary care services in the area.

Reference has been made to ambulance journey times. I agree that the performance of the London ambulance service has been disappointing compared with other parts of the country, but we have considerable confidence that it will improve. In an age of paramedics--we are aiming soon to have a paramedic on every front-line vehicle--the location of accident and emergency departments, in terms of trauma, is perhaps becoming subsidiary to the location of ambulances and the ability to get an ambulance to the scene. Again, it has been said that closing Oldchurch A and E would put too much pressure on neighbouring hospitals, including King George and the Newham general. Likewise, the population of Dagenham and Barking seems likely to increase as housing developments in the east Thames corridor get off the ground, not forgetting that cancer and neuroscience specialties are already located at Oldchurch. The arguments for Harold Wood include, importantly, the fact that changes could be achieved much more quickly on the Harold Wood site because there are far fewer constraints and because the layout of existing buildings at Oldchurch mitigates against development. There is undoubtedly, for the same reason, the question of difference of cost. There is no doubt that existing facilities at Harold Wood are of a higher standard, and the backlog of maintenance costs is high at Oldchurch.

The specialty reviews considered Oldchurch to be unsuitable for retention of cancer and neuroscience work, and clearly the local health authorities support development of these specialties at Harold Wood. It has been suggested to me that the London ambulance service favours Harold Wood if there is to be a single-site option. As my hon. Friend the Member for Romford knows, the health authority met formally on 7 April to consider the outcome of its consultation. I understand that the local community health council has asked for further appraisal of the proposed location. At its meeting on 5 May, the health authority decided to stick with the proposals and, as the CHC maintained its opposition, the matter was referred to the regional health authority.

I am told that there was considerable debate at the regional health authority meeting on 13 June, when a decision was taken to support the strategy of centralising services at Harold Wood, but with three qualifications : that appropriate alternative arrangements should be in place

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before any closure of A and E facilities ; that adequate arrangements should be made and implemented for road access to Harold Wood ; and that adequate and appropriate interim arrangements should be in place for the redevelopment phase.

I understand the strength of feeling about this matter and I confirm that if the matter comes to Ministers, what has been said this evening will be taken into account. I have no doubt that I can include my hon. Friends the

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Members for Hornchurch (Mr. Squire) and for Ilford, North (Mr. Bendall) in the concern that has been expressed about the matter. I cannot say more than that at present, as all hon. Members who have spoken will understand, but I recognise that this is a matter of deep concern.

Question put and agreed to.

Adjourned accordingly at eight minutes past Twelve midnight.

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