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The key aim of self-assessment is to reduce the overall costs of running the tax system. A more straightforward system will deliver that, and will provide significant savings for the self- employed by sweeping away all the complexity of the old rules. That will allow businesses to concentrate their energies where they really belong--on creating wealth.

As with any new system, people in business and others who receive returns and their advisers will need to learn new rules. I recognise that there will be some initial costs for those affected. Some employees will need more information than they do now about benefits in kind and expenses payments, so that they can complete a tax return if they receive one. That will also mean more work for some employers--those who do not provide that information to their employees, but who will need to do so.

We have tried to keep business costs to the absolute minimum by consulting as widely as possible on the best way forward, listening carefully to what people had to say. We are continuing with those consultations. Indeed, members of the self-assessment consultative committee were good enough to come to a meeting at the Treasury just before Christmas, so that I could hear their views at first hand. A substantial programme of publicity and education for taxpayers is planned and is under way. Particular emphasis will be given to raising awareness and to tax advisers understanding the changes through mailings and presentations.

Some deregulatory savings will arise from self-assessment. Both the cost and savings are documented in detail in the comprehensive compliance cost assessment that we published on Budget day. Notwithstanding such costs, the overall impact on business is expected to be positive and to produce continuing savings of between £125 million and £250 million per year in business costs. The main beneficiaries of that will be the self- employed. I can tell the hon. Member for Darlington that the aim of self- assessment is to help people to get their tax right first time. This will involve making them aware of their responsibilities through the programme of education and publicity that I mentioned.

9 pm

The design of the tax return and the guidance notes will also have an important role. We are consulting taxpayers, professional advisers and Revenue staff and we are also undertaking research to help design a return that is as easy to understand and as simple to complete as possible. The response to the consultation has been excellent, with strong interest from not only agents but the public. Indeed, more than 1,000 people volunteered to try out the new return for themselves--it says something for the popularity of the new scheme when people are volunteering to fill in a new return that they are not obliged to fill in. Consultation on the new tax return will continue throughout 1995.

The consultations centre on the traditional paper tax return but self- assessment is a system for the future and clause 136 includes the measures necessary to enable taxpayers to file their returns electronically. However, our plans do not stop at electronic lodgement. Many taxpayers already have personal computers at home and, in the

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future, even more will have computer skills. Filling in a tax return, especially under self-assessment, is an activity which, I believe, lends itself naturally to the use of a personal computer- -it can do the calculations and it can access the right help screen. I have, therefore, encouraged the Inland Revenue to consider urgently the possibility of producing a version of the return on computer disk, but it need not be something that the Revenue itself produces--it is a natural candidate for private sector involvement or partnership. Either way, I regard it as an exciting development and the right way forward.

Finally, whether people decide to use a paper return, a computer disk or electronic lodgement, self-assessment will be a big change and people are likely to need help of one kind or another from the Revenue. That brings me to a point made by the hon. Members for Darlington and for Durham, North- West. The Revenue will be embarking on an ambitious and comprehensive customer service programme to inform and assist taxpayers so that they can understand the new system and comply with their obligations.

The Revenue is currently conducting research into taxpayers' needs and consulting extensively on all aspects of its programme. The results of that work will help it develop the most effective and efficient service using, for example, carefully targeted written guidance on the telephone and face to face through the network of tax inquiry centres. The Revenue now has nearly 400 such inquiry centres and I have been impressed by the high standards of service that they provide. Hon. Members may have raised other issues but I shall write to them, if I may.

We shall, of course, continue to keep the House informed of developments as we move towards full implementation of

self-assessment. We expect to introduce further self-assessment legislation, the third and--I hope--final tranche being in next year's Finance Bill. That will provide ample opportunity for further parliamentary discussion on the progress of self-assessment and other clauses which will be dealt with in Standing Committee.

Against that background, I hope that I have given the hon. Member for Durham, North-West sufficient assurance to persuade her not to press the amendment to a Division.

Ms Armstrong: I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn .

Clause 91 ordered to stand part of the Bill .

To report progress and ask leave to sit again.-- [Mr. Bates.] Committee report progress: to sit again tomorrow.



That, in relation to the Children (Scotland) Bill, Standing Order No. 91 (Special Standing Committees) shall have effect with the following alterations:

(a) in line 6, leave out `four morning sittings' and insert `two morning and two afternoon sittings'; and

(b) in line 18, leave out `three morning sittings' and insert `one morning and two afternoon sittings'.-- [Mr. Bates.]

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Queen Elizabeth II Hospital (Welwyn Hatfield) Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Bates.]

9.4 pm

Mr. David Evans (Welwyn Hatfield): As the House knows, "Queen Elizabeth II" stands for the greatest living monarch and the world's loveliest cruise ship, but only the people of Welwyn Hatfield know that Queen Elizabeth II is also one of the country's finest hospitals. It dispenses more love and care to my constituents than probably any other hospital in the United Kingdom does to its patients. That is why it is named after a great lady and a great ship.

I am grateful for the opportunity to raise the issue of the Queen Elizabeth II hospital in Welwyn Hatfield. The QE2 is an efficient, successful and vibrant hospital. Since receiving trust status in 1991, in-patient and day case operations have increased by 28 per cent.; the average waiting time has dropped from seven months in 1989-90 to just three months in 1993-94, which is well below the national average; and, since 1991, the QE2 has introduced a number of new developments and schemes.

They were: first, the Danesbury home for the accommodation of physically handicapped people; secondly, a day surgery unit; thirdly, a magnetic resonance imaging unit which saves unnecessary journeys to central London; fourthly, new ultrasound equipment to enable the women of Welwyn Hatfield to produce bigger bouncing babies; fifthly, new computer systems to take care of patients' medical records; sixthly, delivery suite recovery rooms for the bigger bouncing babies; seventhly, the construction on level 8 of Cuffley ward for general surgery, thus freeing other facilities for medical emergencies; eighthly, the conversion of level 6 Bramfield ward for medically dependent patients; ninthly, the construction of a stroke rehabilitation unit at Queen Victoria memorial hospital to help the victims of heart attacks; tenthly, the construction of a children's out-patients facility helping mums and dads stay together; eleventhly, the construction of a post-natal mother and baby unit called Thumbswood ward; twelfthly, the installation of security closed circuit television to prevent baby snatching; thirteenthly, an assessment unit for the accident and emergency department; fourteenthly, a new orthopaedic unit to get my constituents up and running as soon as possible; and, fifteenthly, a host of minor works, repairs, improvements and new equipment. Since 1991, total expenditure has amounted to £13 million. That is £175 for every one of my constituents.

May I take this opportunity to thank all my parliamentary colleagues in Hertfordshire for their support over a long period on this issue? I would especially like to thank my hon. Friends the Members for Broxbourne (Mrs. Roe), for Hertford and Stortford (Mr. Wells) and for Stevenage (Mr. Wood). Since my hon. Friends the Members for Hertsmere (Mr. Clappison) and for Hertfordshire, North (Mr. Heald) came into the House, they have given me equally strong support. I thank them for all the effort that has gone into this hospital.

I am very proud of our national health service. It has developed and flourished under successive Conservative Governments, who have invested additional funds in real terms in the service each and every year since 1979. Indeed, that commitment has resulted in an even greater

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proportion of gross national product being directed towards health; from 4.7 per cent. in 1979--the legacy left for us by the Labour party--to 6.1 per cent. currently.

The Secretary of State has already announced a further large injection of funds for the forthcoming year. For the year 1993-94, a massive £37,000 million has been invested to provide a comprehensive and efficient health service, which is still the envy of the world and which is available to every man, woman and child in Britain, irrespective of age, race, colour or creed.

Why is it the envy of the world? Why do health professionals visits from Europe and America to find out how we provide such good value for money in health care? The answer is simple--because of the health service reforms introduced by this Government in 1991. As a result of those reforms, the country now benefits from more health facilities and ever-increasing quality. But that cannot be taken for granted--nor would it continue under a Labour Government. Let us, to set the background, take the lot opposite for a trip down memory lane and remind them exactly what happened under the last Labour Government. First, in 1977-78, the health budget was cut by 3 per cent. in real terms. Secondly, the capital spending was cut by one third in real terms; the largest ever cut inflicted on the NHS capital programme in the entire history of the national health service. Aneurin Bevan, eat your heart out. Thirdly, between 1974 and 1979, in real terms, nurses' pay fell by 21 per cent., doctors' pay by 16 per cent. and surgeons' pay by 25 per cent.

Fourthly, in 1978-79, the NHS went on strike, led by the Confederation of Health Service Employees and the National Union of Public Employees. Telephonists were on strike and clinical staff were manning public call boxes to get calls into the hospital. Clean linen was not allowed through picket lines. Foul linen was destroyed, because the unions would not let it out of the hospital. Meals were provided by volunteers and cleaning of the hospitals was virtually non-existent. Drugs and medicines were not allowed in. Cancer parents were refused treatment and left on the pavements. Hospitals were brought to their knees and the QE2, under Labour, was shut down. During the winter of discontent, Barbara Castle, the former Labour Secretary of State for Health and Social Services, described her attack on pay beds as an "essential political sweetener" for the trade unions. Let no one forget that the Labour party has 156 Members who are sponsored by unions, including the whole of their Front-Bench team. As we all know, balding Bambi is sponsored by the Transport and General Workers Union.

We will not be fooled by their £500 suits or their £60 hairdos. They are still committed to tossing political sweeteners to unions and, in return, the unions toss financial sweeteners to the Labour party. As the leader of the TGWU said last year, "No say, no pay." One has to ask oneself what sort of health service we would have under the direction of the right hon. Member for Kingston upon Hull, East (Mr. Prescott), who cannot even remember where he parked his car.

Labour's political interference in the Government's health reforms could be identified back in 1990, when the poisoned dwarf, the hon. Member for Livingston (Mr. Cook), who at the time was the Labour spokesman for health, threatened NHS managers working on implementing the Government's health reforms. In a

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blatant threat, the hon. Member for Livingston told them to go slow on the Government's health reforms, because they would all be reversed by the next Labour Government.

The Health Service Journal condemned the outrageous interference of the hon. Member for Livingston when it stated:

"The threat was barely veiled: Everyone judged to have appeared too enthusiastic about the White Paper need not expect to have their contract renewed by a Labour Health Secretary."

The journal went on to describe the hon. Gentleman's actions as "outrageous interference in NHS management and flagrant intimidation of NHS managers."

So much for democracy.

Now let us consider what has been achieved by the Government, and the implications of that for the QE2. Between 1979 and 1992 the number of nurses and midwives increased by nearly 25,000, and the number of medical and dental staff by nearly 10,000. Nurses' pay has risen by not less than 53 per cent., and doctors' pay by 35 per cent, since 1979.

Since the reforms were introduced in 1991, the number of patients treated in hospital has increased by 5 per cent. a year, compared with an increase of 2.4 per cent. a year between 1979 and 1991. The rate of increase during the latter part of the 1970s--the last period of Labour so-called Government--was a paltry 1 per cent. Of course, under Labour the number of shop stewards in the health service increased even faster than the number of top-class doctors leaving the country. Denis Healey made the pips squeak all right, and under Barbara Castle they were left squeaking.

The number of patients treated in hospitals has increased from 7 million in 1991-92 to 8 million in 1993-94--a truly remarkable achievement. Waiting times have fallen, as have the numbers waiting. Half of all patients are seen immediately and 30 per cent. of the rest are seen within 2 weeks; 75 per cent. of patients are seen within three months, and 98 per cent. within the year.

The reforms have changed the system from a provider-led to a purchaser-led service. Under Conservative leadership, there has been a substantial programme of hospital modernisation and building. More than 800 hospital building schemes, each worth more than £1 million, have been completed since 1980, and almost another 300 are in the pipeline.

The purchaser now calls the tune, identifying need and responding to the requirements of the local population, setting contracts to ensure that hospitals and community units know what services and how many services will be required of them, so that they can plan their delivery with optimum staff numbers and the right number of beds. Gone is the boom-bust mentality that characterised the provision of care before the reforms--hospitals working flat out with all their beds open for the first two thirds of each year, and then coping with bed closures because the money had run out, resulting in the indiscriminate cancellation of urgent as well as routine operations. Yes, I am proud to be associated with a Government who have had the vision and courage to introduce such fundamental

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changes, and who have ensured that care has improved so much. Until the reforms, most hospital calendars ran for only nine months of the year.

However, there is a problem. That success depends on the highest quality of purchasing if services are to be provided in the best possible way. My constituency has suffered because purchasers published an ill-conceived, badly researched and poorly written document. It is called "Where do we want to be?"--God knows, but not where they suggest. That so-called strategic discussion document was released because the purchasers wanted to tell the public that all their services had to be reviewed and that the number of accident and emergency departments in Hertfordshire might be reduced from four to two.

The proposal, which was based on badly researched data, has caused enormous anger and resulted in great anxiety for the population of Hertfordshire, not least our proud independent senior citizens, who want to be loved and cared for as they reach old age, not to have some upstart terrify them with an awful ill-conceived document. Why has there been so much trouble? First, because we love our hospital and, secondly, because that document implied, although it did not state it, that our local hospital, the Queen Elizabeth II hospital of Welwyn Garden City, was the prime candidate for reduction of accident and emergency services and for subsequent complete closure.

Such a proposal, albeit for discussion, is a disgrace, because our hospital has provided a model for demonstrating the success of the reforms. During the 1980s, it was not successful. Morale was low. There were financial difficulties. Delays for treatment were considerable.

In those days, we were starved of cash, not by the Government, but by Sir William Doughty. I have to tell you, Madam Deputy Speaker, that he did not receive his knighthood for a contribution to the health service--that would be too much of a joke. In his role as chairman of North West Thames regional health authority, he enabled the more favoured inner-London parts of the region to be overfunded. For every £1 spent on health care for someone in Brent, only 75p was spent on care for someone living in Welwyn Hatfield.

Back in 1989, the North West Thames regional health authority used a formula designed by Mr. Doughty for allocating the money provided by Government, which resulted in 11 districts being overfunded and two underfunded. East Hertfordshire was underfunded by £400,000. It was unacceptable to watch the budget for East Hertfordshire district continually cut to subsidise financial disasters such as the construction of the Chelsea and Westminster hospital, which, let me tell you, Madam Deputy Speaker, was originally estimated to cost £70 million. It did not cost £70 million; it did not cost £80 million; it did not cost £90 million, or £100 million, or £110 million, or £120 million, or £130 million, or £140 million, or £150 million, or £160 million, or £170 million, or £180 million, or £190 million, or £200 million, or £210 million, or £220 million, or £230 million. It cost £245 million.

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Every capital project in our region was suspended for five years to accommodate Sir William Doughty and his bloody silly hospital. Mr. Vivian Bendall (Ilford, North) rose --

Madam Deputy Speaker (Dame Janet Fookes): Order. I know that the hon. Gentleman feels strongly, but I do deprecate some of his language, and I would ask him to moderate it.

Mr. Bendall: So my hon. Friend would agree with me that inner London has been doing very well at the expense not only of his area but also of peripheral London?

Mr. Evans: My hon. Friend makes his own argument very well. It is a disturbing fact, and we are seriously worried about it. However, when East Hertfordshire obtained trust status, it changed entirely. It became an acknowledged success, recognised as such by my right hon. Friend the Member for Peterborough (Dr. Mawhinney) when he visited my constituency in his capacity as the Minister of State for Health. Waiting times have declined. Contracts for services were all met and the trust has finished its financial years either in balance or in surplus.

During the 1980s, I used to hear lots of complaints about the way that services were provided.

Now, the population is proud of its hospital and the high quality of care that it provides. Its accident and emergency department, which was threatened by the purchasing agency, is the biggest in the county of Hertfordshire. It is the most central, the newest and the only department that already meets the patients charter standards for out-patients.

According to the purchaser's own publication, it is the cheapest department per patient in Hertfordshire. It is the only accident and emergency unit where patient numbers are increasing. It is forecast that, within five years, it will be one third larger than the next largest department in the county. It has the lowest management costs in the region. It serves a catchment population of 500,000 people, all of whom live within 20 minutes travelling time, which means that it is pivotal as an emergency hospital service in the county of Hertfordshire.

The residents of east Hertfordshire have lost access over the past 10 years to accident and emergency services at the Hertfordshire and Essex hospital, Hertford county hospital and St. Albans city hospital. Part of the argument to support the closures of those units was the existence of the accident and emergency unit at the Queen Elizabeth II hospital which has, as a result, grown from one of the smallest units, to overtake all others and become the biggest unit. It will treat more than 50,000 new patients this year.

Why should that success story be overshadowed by threats of closure? The reason is simple--bureaucrats. A few managers in the purchasing authority decide that a hospital can be closed. Despite such phenomenal success, all the principles that I have espoused will be sluiced away with the bedpans. Purchaser dogma cannot overrule popularity, people, patients and success. Surely, the thrust of the Government reforms is that successful hospitals and accident and emergency units attract more patients and so receive more funding. Funding follows the patients--at least, that was the idea until the paper-cushioned bureaucrats stuck their biro in.

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Jenny Griffiths, the chief executive of the Hertfordshire health agency, who has a closet socialist background, followed her own little principles. She believes--as all socialists believe --that the funding should follow the white elephants and cause mayhem within a Conservative success story. As always, the Labour party, nationally and locally, has tried to make the matter a political one. Its claim that there is not enough money in the Queen Elizabeth II hospital is clearly a blatant lie, and shows a total lack of knowledge of trust status. In any case, the issue is about how a local purchaser behaves. The Hertfordshire health agency is for the benefit of patients and their families.

If the issue is to be party political, so be it. Let me tell the world that the Conservative party and the Government have ensured that the Queen Elizabeth II hospital has flourished. My right hon. Friend the Secretary of State for Health and the bureaucrats between her and the point of patient care need to know and understand that the hospital belongs to the people. We, the people of Welwyn Hatfield, will not allow anyone who seeks promotion by trying to be too clever by half at the expense of patients who are my constituents. I will be vigilant, aggressive, abrasive, determined and committed to the well-being of my constituents, the hospital management, doctors, consultants, nurses, ancillary staff and the hospital itself. If anyone in the House or outside it regards that as a threat, I can tell them right now that it is--"David Evans is watching you. Hands off our hospital". Can the Minister say here and now that there are no plans to close any accident and emergency departments in Hertfordshire, particularly the accident and emergency department at the Queen Elizabeth hospital?

9.30 pm

Mr. Oliver Heald (Hertfordshire, North): My hon. Friend the Member for Welwyn Hatfield (Mr. Evans) has done the House a service in bringing this important matter before us tonight. My constituents in north Hertfordshire use two hospitals. In the south and the west, they use the QE2 and they consider it to be as good a hospital as my hon. Friend has explained to the House. To the north and the east of my constituency, my constituents use the Lister hospital in Stevenage.

I see that my hon. Friend the Member for Stevenage (Mr. Wood) is in his place on the Treasury Bench. My hon. Friend the Member for Welwyn Hatfield said that his hospital provides excellent services and has improved its facilities in recent years, and so too has the Lister hospital, the other main hospital that my constituents use. The hospital has a new renal unit, an improved cancer facility and improved screening facilities. There is a new entrance at the hospital and new car parking facilities. A brand new outreach clinic at Baldock costing £500,000 opened last year. The other satellite hospitals that look to the Lister--such as the Hitchin hospital and the Royston hospital--also provide excellent facilities, including local physiotherapy services.

The people of Hertfordshire and the county health service have embraced the Government's reforms. We were the first county with a major tranche of general practitioner fundholders--we led the way. We adopted trust hospitals at an early stage because we believed in them. We said that the Government's reforms would reduce waiting lists--and, by goodness, they have.

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It is against that background that the disgraceful and insensitive consultation document, published in October last year, proved such a shock to everyone in Hertfordshire. It was an opaque document; people could not understand it. It seemed to suggest that accident and emergency departments at the QE2 and Lister hospitals, which are needed and valued by my constituents, might be closed. It suggested that, because of the number of admissions that would be lost to our hospitals, one of them might have to close.

The community health council was shocked. The district councils--all 10 of them--wrote to the health agency saying that it could not happen. My constituents have written to me and to the regional and national health authorities making that point clear.

When I wrote before Christmas to Sir William Staveley, the chair of the regional health authority, asking for an assurance that the accident and emergency service at Lister and services across Hertfordshire would not be interfered with or diminished, he replied that he would not prejudge the consultation. Since that time, meetings have been held in all the main towns.

Mr. Bendall: Is my hon. Friend aware that the same regional health authority controls my area in Ilford, North and Sir William Staveley is giving the same answers to our questions? I am as deeply concerned about my area as my hon. Friend is about his--and I know a lot about his area because I was a parliamentary candidate there twice in 1974.

Mr. Heald: My hon. Friend makes his point about his part of the world with his usual force.

In my constituency, the narrow country roads between the major trunk roads mean that transport between towns is difficult. Some of my constituents in the south-western villages might have to travel all the way to the Lister hospital instead of the QE2. The fear that long extra travel times would be needed if one of the accident and emergency services was closed has caused great anxiety.

It is wrong that such a document, which was not even a formal consultation document--it was described as a discussion document, among other things-- should be produced. The purchasing authority should have made its intentions absolutely clear and been transparent in its actions.

I hope that the assurance for which my hon. Friend the Member for Welwyn Hatfield asked regarding the QE2 and all accident and emergency departments in Hertfordshire will be given today by my hon. Friend the Minister, as only that will set at rest the minds of my constituents and all those in the surrounding area who are concerned. I know that other Hertfordshire Members would share that view. 9.35 pm

Mr. James Clappison (Hertsmere): I congratulate my hon. Friend the Member for Welwyn Hatfield (Mr. Evans) on the debate and on the powerful speech that he made. It was followed by another powerful speech by my hon. Friend the Member for Hertfordshire, North (Mr. Heald). My hon. Friends have amply demonstrated our commitment to the national health service in Hertfordshire

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and I endorse unreservedly all that they said about the progress that has been made in the health service in Hertfordshire in the past 15 years.

Let me add one footnote to the long list of achievements outlined by my hon. Friends. It is a great pleasure for me that, earlier this month, a brand new community hospital in Potters Bar replaced a building which had stood since the 1930s and which was clearly no longer in the best repair. The new community hospital is a brand new structure. It has excellent facilities offering many new services to my constituents, and the community of Potters Bar is justly proud of it.

Just a little way from Potters Bar, a major redevelopment of Barnet general hospital, long awaited and badly needed, is now being undertaken. I pay tribute to the efforts of my hon. Friend the Member for Chipping Barnet (Mr. Chapman), who is in his place, who long advocated the redevelopment of the hospital. We are pleased that that redevelopment is now taking place.

Let me make the following point about the wider context of the debate.

Mr. Deputy Speaker (Mr. Michael Morris): Order. There is no wider context. The debate is very clear. It is about the future of the QE2 hospital in Welwyn and I should be grateful if the hon. Member addressed that matter.

Mr. Clappison: I beg your pardon, Mr. Deputy Speaker. It was a mistaken way of putting it. The future of Welwyn hospital is tied in with the future of local health services as patients move from one hospital to another.

Clearly, the future of Welwyn hospital has a material impact on my constituents who receive care in other hospitals. The concerns that my hon. Friend the Member for Welwyn Hatfield expressed about the discussion document to which he referred echoed much wider concerns in Hertfordshire. He also spoke for many other people when he referred to the research in that document.

Although I agree with planning health care, those who seek to plan health care must do so on the basis of the best possible research and the fullest consultation, taking into account all views from the public and planning on a long-term basis. I have serious concerns and reservations about whether the document meets those criteria. In the longer-term context, it is not so long ago that I raised in an Adjournment debate the centralisation of hospital services from St. Albans to Hemel Hempstead. That has been followed by further proposals in the document, while modernisation and major redevelopment is taking place in Hemel Hempstead hospital. I mention that because it shows the importance of planning change in the long term, which is clearly relevant to Welwyn hospital.

I invite my hon. Friend the Minister to note widely felt concerns about the future of Welwyn hospital, the discussion document, planning, and the pace and acceptability of change.

9.39 pm

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville): My hon. Friend the Member for Welwyn Hatfield (Mr. Evans) is a hard act to follow, so I shall not detain the House. I appreciate the grave importance of the issue that he raised and the strong

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feelings that it arouses. That is evidenced by the presence in the Chamber and speeches of my hon. Friends the Members for Broxbourne (Mrs. Roe), who is well known for her expertise in health matters, for Hertfordshire, North (Mr. Heald), for Hertsmere (Mr. Clappison), and for Stevenage (Mr. Wood).

There is no doubt that the QE2 is an excellent hospital. I would have enumerated all its virtues but cannot match the eloquence and ferocity with which they were described by my hon. Friend the Member for Welwyn Hatfield. It can be taken as read that we all agree that the QE2 is an exceptional hospital and serves well the people of Welwyn Hatfield and of surrounding constituencies. It could not have a more powerful champion of its interests than my hon. Friend the Member for Welwyn Hatfield.

When we discuss the future, it must be said that hospital care is changing fast. I refer, for example, to greater use of day care. All kinds of services now provided in hospitals may in future be provided in doctors' surgeries, smaller units or even at home. That is making an enormous difference to the need for larger hospitals and the present number of acute beds. That fast-changing position means that at some time in future, the standard district hospital that we all know and love may not be the paradigm of acute care. Things are changing that fast.

Accident and emergency services are also developing fast. The role of paramedics in ambulance services is a powerful factor for change. Many lives are saved by the attendance of paramedics at serious accidents and emergencies and by the use of high-tech facilities in accident and emergency centres. We are starting to see the role played by what are known in America as trauma centres. The experimental centre at Stoke means that five or six district hospitals may be bypassed in the event of a

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serious accident and a patient taken straight to the trauma centre at a hospital providing 24-hour accident and emergency consultant cover.

Apart from full-scale trauma centres, we are seeing the emergence of the need for larger, high-tech accident and emergency centres. They must be accompanied by a full range of acute facilities. We are already witnessing the better outcomes and results of larger accident and emergency centres.

Against that fast-changing background, Hertfordshire health agency produced its discussion document, "Towards a Healthier Hertfordshire", to which my hon. Friend the Member for Welwyn Hatfield and other hon. Friends referred.

I would dissociate myself from one or two details in the remarks of my hon. Friend the Member for Welwyn Hatfield, especially about some current and past servants of the health service. I agree that these are matters that excite powerful emotions and that it is wrong unnecessarily to alarm people about the future of their hospital services.

Having said that, I believe that there may well have to be change not only in Hertfordshire but throughout the country--we are seeing it already in London for reasons that my hon. Friend described so eloquently, and it is long overdue. I can give my hon. Friend the assurances that the Hertfordshire health agency recognises that much work continues to need to be done, that it needs to seek the co-operation and agreement of local trusts in changes that may take place, and that there are currently no plans for changes to accident and emergency provision in the east of Hertfordshire.

Question put and agreed to.

Adjourned accordingly at fifteen minutes to Ten o'clock.

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