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18 Nov 2008 : Column 47WH—continued

The conclusion reached by the specialist was that Mr. Nord had been suffering from something known as ketoacidosis or, in layman’s terms, dehydration. Had he been given fluids he would easily have been resuscitated. That raises the question why that treatment was not given. Probably, Mr. Nord, being on holiday in Indonesia, had drunk too much and not looked after his diet as he should have done, and developed a severe case of dehydration, which led to his death. That death, according to the specialist, was entirely preventable.

Several questions about consular assistance to individuals abroad are raised by this case. I repeat my question: if a person is incapacitated and cannot speak or is unconscious when admitted to hospital—even if they have insurance or money—what assistance can or should be provided to ensure that the individual is not put in Mr. Nord’s situation and left to die? Why was the consular officer on duty that evening, by his own admission, so badly equipped to deal with the situation? He mentioned that it was not his day job and that he required an interpreter before he went to the hospital. In the end when he found out that Mr. Nord’s companion was Indonesian and could interpret, he visited the hospital. The officer mentioned that he knew that the country operated on a system of bribery. Why does the Foreign Office not have protocols or procedures in place, so that if it is known that there might be a request for a cash payment in advance of medical treatment an attempt can be made to get round the situation and assist an individual? Obviously it is not the easiest matter for the Foreign Office to make reference to another country’s being corrupt. However, it happens. There are countries where a level of corruption is acceptable, when it is not here. There should be some system to get round situations in which a bribe or some such payment could be anticipated.

Even if there was no request for a bribe, and even if the hospital was the best in Jakarta and had, in the words of the Foreign Office,

why was Mr. Nord allowed to die while embassy officers and doctors stood and let him? Surely there is something wrong with the system, no matter how good the hospital and its procedures, when a man is admitted to hospital and dies in this way in 12 hours. There is something wrong with the system and we need to consider it again.

I appreciate that the Foreign Office goes to great lengths to publicise its consular guidance and make individuals aware that there is no financial assistance and that there are no medical payments or guarantees. However, surely there must be a system that allows for a situation such as the one I have set out, and in which a person can be given some assistance at least to prevent a tragic outcome. If the Foreign Office takes the view that the guidance is sound and there is no reason to change it, surely the information that is provided must go
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further, and include such situations. Individuals should be alerted to the fact that they could be asked for cash payments, with no question of insurance or credit cards being used. The people in Mr. Nord’s case were not asked for insurance or a credit card payment. They were asked for 1,700 US dollars—not sterling or Indonesian currency. It was quite specific. Surely some reference should be made in the guidance to the fact that there are countries where such a demand will be made.

The version of events in the correspondence that I exchanged with the Foreign Office does not equate to the version in statements provided by people who were present at the hospital. I question why the Foreign Office has chosen to accept its version of events in the light of clear evidence that some information given by the doctors on the fateful night was absolutely wrong. The man in question did not receive treatment, and was not asked for payments in the normal course of private treatment. He was asked for a cash payment up front.

I accept that the Foreign Office consular guidance is clear and that consular officials are not medically trained and should not be required to give medical advice. However, I am sure that I and the British public expect a better service from our consular staff abroad than was provided to Mr. Nord on the day he died.

12.47 pm

The Minister of State, Foreign and Commonwealth Office (Bill Rammell): I congratulate my hon. Friend the Member for Barnsley, Central (Mr. Illsley) on securing this debate, on behalf of his constituent, about the Foreign and Commonwealth Office’s consular assistance policy and, more specifically, the handling of the case of Dale Nord who, as he has said, tragically died in Indonesia in January. I know that the issue has greatly concerned my hon. Friend, who has pursued it vigorously. I would like to take this opportunity to express my condolences to the Nord family. I can only imagine how hard it must be to lose a member of one’s family in such circumstances. This is a particularly poignant time as the first anniversary of Dale Nord’s death approaches.

There has been much correspondence between Mr Nord’s sister, April Nord, and the FCO about the events on the day of Mr Nord’s death and I fully appreciate the family’s need to know as much detail as possible about the circumstances. Consular staff in Jakarta and London have tried to provide Ms Nord with as much support and information as we can. I regret it if discrepancies between our records and Ms Nord’s have added further to the family’s distress. I know that Ms Nord does not agree with aspects of the version of events that our duty officer in Jakarta recorded. As we have made clear to her, that is simply a record of what the embassy duty officer was told at the time and the action he took.

My hon. Friend has said that Ms Nord feels she received inaccurate information on the medical condition of her brother from our duty officer. I do not think that it is appropriate in this forum to go into the detail of the information relayed about Mr. Nord’s medical condition, but I reiterate what we have said in previous correspondence: our duty officers are not medically trained personnel; their role in such situations is to relay information between the various parties. They cannot and should not interpret medical information. Any diagnosis and decisions on treatment are made by the relevant medical
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staff. If there was a misdiagnosis of Mr. Nord’s condition—I do not know whether that is the case—our duty officer in no way contributed to it. He was simply passing on the information that he had been given. I must say that, in the circumstances, I do not see what other course of action was available to him.

My hon. Friend also said that the West Yorkshire coroner, who has opened an inquest into Mr. Nord’s death, has concerns in relation to this case. As my hon. Friend knows, in addition to the documents from the hospital that the coroner requested, we have provided him with a statement from the embassy officer who was on duty at the time of Mr. Nord’s death, which records the information that the duty officer was given and the actions that he took, and a statement from the vice-consul in Jakarta, whom the duty officer had consulted. The coroner has not expressed to the FCO any dissatisfaction or reservations about those statements, nor has he asked for any further evidence from the two individuals concerned. I understand that there is one outstanding request from the coroner for information from the hospital itself, which our staff in Jakarta are trying to obtain on his behalf. I hope that we can achieve that outcome.

Clearly, a particularly distressing issue for Mr. Nord’s family is their belief that treatment was withheld from Mr. Nord until such time as the hospital received payment. Hospital treatment in Indonesia is not free and requires either a deposit or a confirmed undertaking to pay from an insurance policy, so it is not unusual that the friends who were with Mr. Nord would have been asked for an initial payment. However, it is our clear understanding from what Mr. Nord’s friend said to the duty officer at the time that in fact, the hospital did not withhold treatment from Mr. Nord until it received the payment that it had requested.

Our belief is that Mr. Nord was treated by the hospital throughout that night and he was certainly being treated when the duty officer from the embassy arrived. Our understanding is that, on his arrival at the hospital at 1.50 am, Mr. Nord was moved to the intensive care unit. Further, the hospital log shows that treatment took place at 3 am and the duty officer from the embassy was first contacted at 3.35 am. That record certainly demonstrates that Mr. Nord had received treatment before the duty officer from the embassy arrived.

One of the main concerns that my hon. Friend and Ms Nord have raised with us is why the FCO could not guarantee payment of Mr. Nord’s medical costs. My hon. Friend has also said that he believes that the FCO should have procedures in place to assist British nationals who need funding in medical emergencies such as this. However, I must say that I do not agree with that view. Unfortunately, a huge number of British nationals end up in hospital overseas each and every year, needing treatment. Indeed, there have been almost 3,000 cases already this year that we have been notified about. The UK Government cannot pay the medical costs of those individuals, nor can we provide financial guarantees on their behalf.

The FCO has invested substantial resources in making it clear to British nationals who are travelling or living overseas that they need to have full travel insurance. Our consular directorate’s “Know before you go” campaign was launched in 2001 to encourage British nationals to take the necessary precautions to ensure that they have safe and trouble-free travel abroad. The need to obtain
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comprehensive insurance is one of the campaign’s key messages, and a wide range of methods and partnerships are used to promote it. The FCO’s travel advice on its website includes suggestions about what a travel insurance policy should cover, and what the real cost of medical treatment could be for those who travel without insurance.

As my hon. Friend is probably also aware, in 2006 the FCO published a booklet, “Support for British Nationals Abroad: A Guide”, which clearly sets out what we can do and, just as importantly, what we cannot do for British nationals overseas. Page 16 of that booklet explicitly states:

With regard to this specific case, our duty officer was therefore correct in saying that he could not guarantee payment of the medical bills on the Nord family’s behalf. I must say that if we were to make such an undertaking in individual cases, we would have to do it in every case, the cost of which would be colossal, and I believe that the resulting burden on the taxpayer would be both unreasonable and unaffordable.

As my hon. Friend knows, the duty officer at the embassy went to the hospital where Mr. Nord was being treated and he tried to facilitate a credit card payment by Mr. Nord’s family, but I understand that that payment was refused because the hospital’s standing instructions required its accounts office to see the original credit card. Of course, I understand the additional distress that can be caused when funds are needed in an emergency and that any time delay in the transfer of funds adds to that distress. Although it will bring little comfort to the Nord family at this time, they may want to know that the FCO is examining the possibility that in some emergencies where British nationals are in urgent need of funds, we will be able to take card payments ourselves directly from friends or family in the UK, and thereby, in situations such as this one, quickly facilitate payment to a hospital overseas.

Ms Nord has also expressed reservations that the person on duty at the embassy, who was not a consular officer, may not have been best placed to provide assistance to her brother and herself; indeed, those concerns have also been expressed by my hon. Friend this afternoon. I must point out that duty officers deal with all inquiries to an embassy’s out-of-hours emergency number, many of which are not about consular issues. In this case, although the duty officer was not working in a consular position in the Jakarta embassy, he had previous consular experience. He also spoke to the vice-consul at the post to brief him on the situation and on the actions that he had taken. The vice-consul confirmed to the duty officer that he was following consular guidance in dealing with this situation.

Although I again appreciate that it will not alleviate the Nord family’s distress at their loss, the FCO is reviewing how we deal with out-of-hours calls to our missions overseas and examining how we can ensure that we have as consistent and professional a service as possible out of hours, as well as during the working day. As I have said, I appreciate that that does not help Ms Nord and her family, but I hope that the House will note that we are continually looking for ways to improve the consular service that we offer to British nationals overseas, particularly those in serious distress.

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Having said all that, I genuinely understand the concerns of relatives when, as in this case, someone dies tragically thousands of miles away in a situation that the relatives feel they have no influence over. It is a tragic situation; this incident was a tragic accident. However, nothing will bring Mr. Nord back. Nevertheless, if it would help I am happy to meet my hon. Friend and his constituent to explain as fully as possible our actions and those of our consular staff, and our understanding of exactly what took place. Sometimes, such a meeting can be a better forum within which to discuss these matters than an Adjournment debate in the House.

As I said at the beginning of this debate, I genuinely and deeply regret that this tragic situation has been made worse for Mr. Nord’s family by their belief that he was treated neither promptly nor correctly by medical staff at Pertamina hospital, and by their dissatisfaction with the assistance that the duty officer at our embassy in Jakarta provided. However, I am satisfied that the duty officer provided the appropriate consular assistance. Much as we might like it to be otherwise, it was not in his power to guarantee payments for Mr. Nord’s treatment, nor was it in his power to interpret any medical diagnoses. I simply do not think that either of those actions would have been possible in the circumstances. Nevertheless, the offer that I have made to meet my hon. Friend to discuss this case is a genuine one, and I will happily meet him if that is what he wishes to do.

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Digital Broadcasting (West Dorset)

12.58 pm

Mr. Oliver Letwin (West Dorset) (Con): I can genuinely say, Mr. Key, that it is a delight to serve under your chairmanship.

I asked for this debate because, a few years ago, I found myself, as Members of Parliament do from time to time, at a meeting in a Committee Room that had been booked by outsiders who were explaining some matters to us. I was not at all sure that I really needed to be there but I had gone along for the ride, so to speak. At the meeting, a rather large map of Great Britain was projected electronically on the wall. It was very heavily shaded in some parts, and it showed the digital coverage that would be achieved with the digital switchover. There were just a very few points of white on this impressively shaded map. The people who held the meeting were from what is now Digital UK, as well as other groups, and they explained that the coverage was magnificent and it was only the tiny white points where there would not be any coverage.

I am as blind as a bat, as you might know, Mr. Key, so I had to take out my glasses, but even that did not work. I had to walk over and get close to the screen to see that my constituency and that of my neighbour in South Dorset were pinpointed with unerring accuracy as the two in the whole of the south of England that will not be well covered by digital broadcasting. As you might imagine, Mr. Key, I suddenly became extremely interested in the meeting.

That meeting led to the formation of the Dorset broadcasting action group, which is known as DorBAG. We have had a series of constructive and useful meetings with representatives of Digital UK and the BBC at various levels. I have also had meetings with the director-general of the BBC and members of the central staff, as well as with Ofcom and a range of other relevant parties, and some progress has been made. Many of my constituents who will not be served by digital terrestrial broadcasting, due to the lie of the land, will nevertheless be able to get hold of Freesat, which was not available when I was stuck in that room looking at the map. That will enable them to receive digital broadcasts without having to deal with Mr. Murdoch. However, my constituents, and those in South Dorset, experience significant problems with news coverage that are bound up with more persistent problems that have nothing to do with digital switchover.

The main issue is the so-called “three mux, six mux” problem with which the Minister will be familiar. It so happens that my constituents are served by relay transmitters, although why that is the case is lost in the mists of history. For reasons that I dimly understand—too dimly to give the House any adequate explanation—when digital switchover occurs, people who are served by relays will not receive the full suite of channels that they would get if they were served by a main transmitter. For reasons that I understand even less, that effect is not uniform, so only some of my constituents will have access to the full range of channels.

Having sat down with the experts—of whom I am not one, of course—I have discovered that on some streets in my constituency, people on one side will receive the full set of channels whereas those on the
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other side will not. You will understand, Mr. Key, from your extensive experience as the conscientious Member for Salisbury, the kind of civil unrest and the postbag that will be generated for me and my neighbour in South Dorset—whoever that may be—if our constituents can compare notes. Suppose that Mrs. Jones discourses, in the shop, on the merits of the programme that she saw the night before, but Mrs. Smith could not get it. That will not make Mrs. Smith happy, not least because she is paying the same licence fee as Mrs. Jones. Nothing on earth will persuade Mrs. Smith that that situation should have occurred.

The Government’s account—I know this because I have tabled parliamentary questions and have written letters on the matter—is that the decision is a commercial one, and it is not theirs to take. They say that it is the commercial broadcasters that have decided not to foot the bill for making a full suite of channels available to all my constituents, but there is a hitch in that argument. It is true that the broadcasters have taken that decision, but I have no doubt that if there were no regulation at all, they would have chosen to serve only the urban concentrations. They might well have decided that it simply was not worth serving people in West Dorset or, while we are at it, perhaps even those in Salisbury. In general, what compels them to serve a wide population and to give access to programming is the regulatory framework that is partly designed to have exactly that effect, and rightly so. I do not think that the Government can skip out of the matter by arguing that it is a commercial decision, because underpinning that decision is a regulatory framework that does not compel broadcasters to provide equivalent levels of service where technically possible, which it is in this case, to all the residents of an area.

There has been a regulatory failure, but we do not necessarily need a regulatory solution. There is a practical, humdrum solution that would also solve a second problem that I want to raise with the Minister. I have already raised it with the director-general of the BBC and some of his colleagues, and DorBAG has raised it at various levels within the BBC. In West Dorset and South Dorset, we suffer from being on the margin. Poole and Bournemouth are, culturally speaking, part of the south of England, whereas Exeter and Plymouth are, culturally speaking, part of south-west England. Dorset, particularly West Dorset and South Dorset, lies betwixt the two.

For many years, the BBC and other broadcasters have been unable to decide quite where in the cultural map of Britain South Dorset and West Dorset fit. That problem is not shared by the people of South Dorset and West Dorset. My constituents, who differ in many other respects would, if asked—although I have never tried it—probably respond to a deed poll with a 90 per cent. return answering that they are culturally part of the south-west. We do not feel allied to Hampshire, and we do not look to it. Part of the reason why the geographical county of Dorset was split into the unitaries of Bournemouth and Poole and the rural county of Dorset was precisely because the rural county of Dorset looks west, not east.

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