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Mr. Iain Duncan Smith (Chingford): In a spirit of helpfulness, and as the whole House wishes to get behind his rhetoric about saying no to the judgment, may I suggest to my right hon. and learned Friend that, to send a serious message to both the Commission and our partners in Europe, we should put a one-clause Bill through Parliament, which blocks off access of the courts to the judgment? That will demonstrate to the courts and the European Community that we mean business when we go to the IGC. He will have full support for that.
Mr. Hogg: That is an interesting proposition, but it might have the unfortunate effect of preventing British litigants from suing, for example, the German Government in the German courts.
Mr. Toby Jessel (Twickenham): Does my right hon. and learned Friend agree that the rule of law and the authority of any court flow partly from a broad public acceptance that the court is acting fairly and justly, and that, if any court makes manifestly unfair judgments too often, that court might begin to sow the seeds of its own destruction?
Mr. Hogg: I think that my hon. Friend is probably right about the general proposition. However, I am not sure that I would apply it to this judgment. The fault lies not with the European Court, but with the treaty. Whatever else may be clear, the European Court must interpret the treaty and we can hardly blame it for doing so. That is why we are seeking changes.
Mr. Nicholas Budgen (Wolverhampton, South-West): If the Government lost a case before the Judicial Committee of the House of Lords, would my right hon. and learned Friend expect the Minister concerned to describe it publicly as "crazy" and the House of Commons to be up in arms, or would he expect a rather more respectful attitude to be adopted towards a judicial decision? Is it not clear from the attitude of the Minister, the House and the public that none of us accords to European law the same respect that we accord to domestic law? Is it not also clear that, in the end, we, as a nation, will disobey the laws of the European Union and that that will be part of the route towards a looser relationship between us and Europe?
Mr. Hogg: My hon. Friend is being somewhat disingenuous. He and I have practised for years at the common law Bar and we have appeared before many judges--some wise and some foolish. When we received foolish judgments, he and I never hesitated to say so.
Emergency and Intensive Care
4.11 pm
The Secretary of State for Health (Mr. Stephen Dorrell): With permission, I would like to make a statement about the emergency and intensive care services of the national health service.
The health service exists to provide health care to those with a clinical need. No aspect of its work is more important than its capacity to respond promptly and effectively to emergency need as and when it arises. This winter has seen those emergency services put under considerable strain. At times of peak pressure, some parts of the country have seen increases in the emergency work load of up to 20 per cent. compared with the same period last year.
In those circumstances, resources have inevitably been stretched, but, despite the pressure, the clinical needs of the overwhelming majority of patients have been met. That is a testament to the skills and dedication of the professional staff of the NHS. All of us, and particularly those who have needed to rely on the emergency services, owe them a debt of gratitude.
I told the House earlier this year that I would undertake to ensure that we learn the proper lessons from the general pressure on the emergency services this winter. I shall set out to the House this afternoon the steps that I am taking to ensure that that happens. First, it is important to separate consideration of emergency care from consideration of intensive care: they are separate, although related, issues.
Taking emergency services first, I have today charged the chief executive of the NHS with a specific responsibility of reporting to me at the end of June and again at the end of September on the plans being made by each health authority for emergency services in its area. The chief executive has written to all health authorities and trusts setting out the ground that he expects those plans to cover. In the short term, they will need to show how resources will be managed to meet short-term fluctuations in the work load. They will need to consider the use of admission wards; improving access for patients in the accident and emergency department to hospital diagnostic facilities; the relationship with local social service departments; and a number of other issues that have been shown by experience to contribute to the efficient running of emergency services.
Health authorities must also address a number of longer-term issues. First, they need to consider how they intend to strengthen the purchasing function in emergency care in order to bring a clearer focus on patients' expectations of those services. Secondly, a considerable amount of work must be done in work force planning for A and E services.
Thirdly, I have asked the chief medical officer to undertake a review of emergency care services outside hospital. It is important that health authorities plan for a full range of services, and do not rely only on hospital accident and emergency departments.
Finally, in relation to emergency services, there is one measure of quality of service about which most patients feel strongly: the time spent waiting in an accident and emergency department. The patients charter already contains a standard that calls for a person's immediate
assessment on arrival in the department. The chief executive's review of health authority plans for the emergency services will also examine the scope for developing other standards that are understandable by patients and accepted by the professional staff as relevant indicators of quality.
I turn now to intensive care provision. Today I am publishing the report of a professional working group that has been examining best practice in the use of intensive care. The report underlines the need for a clearer professional consensus on the most effective use of intensive care facilities, and it sets out proposals for the development of that consensus. It also stresses the importance of specific discussions between health authorities and trusts about the allocation of resources to intensive care. Decisions about the resourcing of intensive care cannot be subsumed into general arrangements for other areas.
The report makes two other important recommendations. First, it recommends that plans for intensive care services should make provision for high-dependency beds that can offer care that is more intensive than ward-based care, but less intensive than a fully staffed intensive care unit.
The report concludes that, in those hospitals that have them, these intermediate facilities relieve the pressure on the intensive care unit with the result that NHS resources, both human and financial, are used more effectively.I shall be looking to health authorities to apply these findings in their own areas.
Secondly, the report recommends that the case for a national database to improve the management of intensive care bed availability should be examined. There is no doubt that the emergency bed service has been responsible for a major improvement in intensive care bed management in London and in the south-east since the system was extended last spring. The NHS will now be considering the proposal for a national register, and I shall announce the conclusion of that process this summer.
Finally, I turn to paediatric intensive care. The report of the inquiry into the treatment of Nicholas Geldard, which was published yesterday, highlighted some important failures in the service that he received. The sympathy of all hon. Members will go to Nicholas's family, who have suffered a tragic loss. The north-west region of the NHS has already made clear its determination to address the local issues that were highlighted by the report.
The main national issue that arose from the case was the availability of paediatric intensive care beds. The NHS is already committed to increasing this provision. I agree with the finding of the inquiry that
I have asked the chief executive to prepare a specific report on the implementation of these plans. It will be presented by the end of April, and it will be published.
"the time for talk and discussion about this issue . . . is over".
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