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Lord Wallace of Saltaire: My Lords, while we are discussing NATO nations, I hope that the Minister can help me on this matter. The United Kingdom has committed itself to providing a substantial proportion of the new European rapid reaction force. In view of what he said about multi-national hospitals in Kosovo and Bosnia, is it assumed that the defence medical dimension for the British contribution to that force will be provided from within Britain, or is it assumed that it will be provided in part by other NATO nations?

Lord Burlison: My Lords, I thank the noble Lord for making that point. I hope to give him a specific answer before I have finished replying to the debate.

I return to the point made by the noble Baroness, Lady Cox, and noble Lords in relation to the Haslar hospital. The noble Baroness referred specifically to the new intensive care unit at Haslar and suggested that money had been wasted because intensive care services were subsequently transferred to the Queen Elizabeth Hospital at Portsmouth. The intensive care facilities at Haslar were updated late in 1995, as no doubt the noble Baroness and noble Lords are aware. Before the hospital became a tri-service facility, the reconfiguration of the intensive care services became necessary in 1999 as a result of low throughput of patients combined with a shortage of service manpower.

As regards a possible move to the Royal Defence Medical College from Fort Blockhouse, the Ministry of Defence stated in the future strategy of the Defence Medical Services that ideally the Royal Defence College would be integrated with the new Centre for Defence Medicine. This issue is being examined as part of the work of the Centre for Defence Medicine. The financial cost of such a move has not yet been assessed but it is not expected to amount to anywhere near the figure that I believe was in the mind of the noble Baroness. I am informed that those personnel at the college who visited the University Hospital Birmingham Trust are enthusiastic about the college moving there. Many of us can appreciate the reasons for that enthusiasm.

As to the point raised by the noble Baroness about the use of former service hospitals, such as the Princess Alexandra Hospital at RAF Wroughton and others, there are no plans to reopen former service hospitals at either the Wroughton, Halton or Aldershot sites. The hospitals did not provide sufficient patients or the variety of cases needed to train medical personnel for their operational duties or to obtain the necessary training accreditation of the Royal Colleges. The Wroughton site was sold in January, while the A & E wing of the Cambridge military hospital is being used by the Frimley Park Hospital Trust.

The issue of Royal Air Force consultant physicians and Royal Navy orthopaedic consultants was raised by a number of noble Lords, who asked how many Royal

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Air Force consultant physicians and Royal Navy orthopaedic consultants are in post as at 1st February compared with the number required. There were five Royal Navy orthopaedic consultants against a requirement of 10; at the same date, there were six Royal Air Force consultant physicians against a requirement of six, with a further three filling command and staff posts.

Lord Swinfen: My Lords, I was not specific as to the Royal Navy and the Royal Air Force; I was asking about the Defence Medical Services as a whole.

Lord Burlison: My Lords, I shall respond to the point of the noble Lord, Lord Swinfen, a little later. I was answering a point raised by the noble Baroness about those two areas. I realise that the noble Lord's point went a little further.

As to the point raised in relation to the Centre for Defence Medicine, we plan to have the initial agreement in place for the host trust by 1st April 2000. Detailed discussions are now well under way. The Centre for Defence Medicine is to open by 2001. The rate of development from then on will be by agreement with the University Hospital Birmingham Trust. At the same time, it will meet the requirements of the Defence Medical Services. The Centre for Defence Medicine will open with approximately 100 personnel, including administrative support, on 1st April 2001. It is expected to grow over the next five to 10 years at a rate, and to an optimum size, jointly agreed by the MoD and the trust involved. Detailed planning to ensure the appropriate provision of the manpower to the Centre for Defence Medicine and other Defence Medical Services commitments are currently in hand.

The noble Lord, Lord Swinfen, made reference to the figures. I appreciate that his point is well made. The retention of manpower is vitally important in this area. At 1st December, the total strength of the regular Defence Medical Services was 6,174 against a requirement of 8,530--and that is where the 28 per cent shortfall that I mentioned earlier comes in. Between December 1998 and November 1999, a total of 25 medical officers submitted applications for premature voluntary retirement. Of the 25, 19 were specialists and six were GPs. As of 1st December 1999, the total strength of medical officers was 865, including all trainees, against a post-SDR requirement of 1,201. That represents a shortfall of 28 per cent. Twenty-five applications for premature, voluntary retirement represent 4.6 per cent of the total strength.

I may not have covered all the points raised in the debate. I know that I have not covered the point raised by the noble Lord, Lord Swinfen, on the traumatologists. That issue is rather complex and I should like to write to the noble Lord. The noble Lord, Lord Wallace of Saltaire, felt that the training margin has been lost. All noble Lords have concerns on that issue. But I hope that from what I have said tonight with regard to the Centre for Defence Medicine and the Ministry of Defence hospital units, the training margin in the future may well be protected and, indeed, enhanced. We are on a much better course in that respect at the moment.

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The noble and gallant Lord, Lord Bramall, asked about reserves. He mentioned that the reserves were indeed, in the main, National Health Service reserves. That is accepted and, with that in mind, the MoD is in constant dialogue with the National Health Service. I am pleased to say that the relationship between the National Health Service and, indeed, the MoD, is at its best. A number of liaison groups and committees have been set up to discuss matters of common interest, such as personnel issues, operational planning and the application to the Defence Medical Services of developments in civilian medical practice.

The noble Lord, Lord Wallace, and other noble Lords referred to wages within the Defence Medical Services. The re-organisation of the Defence Medical Services in recent years has meant that medical personnel of the three services now work more closely together. Different terms of service created some problems and have become a source of discontent. Rationalised terms of service for medical and dental officers have been agreed and proposed pay spines based on the terms of service have recently been submitted to the Armed Forces Pay Review Body for agreement in principle. Rationalised terms of service for nurses have been agreed in principle also.

The noble and gallant Lord, Lord Carver, asked about the Ministry of Defence hospital units. They are working well, providing an excellent clinical environment and representing good value for money. It is clear that the majority of younger medical officers value the training opportunities created by the patient volume in the case mix provided by the MoD hospital units.

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I have been warned that I have run out of time. I have not been able to cover a number of points.

Earl Attlee: My Lords, my noble friend's Question referred to the event of future conflict. Will the Minister say whether we can support an armoured brigade in operations without calling out the TA?

Lord Burlison: My Lords, it would not be appropriate for me to answer that query with a quick reply. But it is a fair question. Some time needs to be spent on it, which is not available to me tonight. However, I will respond to that point and I thank the noble Earl, Lord Attlee, for raising the issue.

The noble Earl asked about the present availability of operational deployment. It is not possible to say how many medical personnel are required to support a particular size of force. It depends on whether the force is employed in war fighting or peacekeeping operations and with whom the UK forces might be deployed. I know that that is only a brief answer to what was a perfectly valid question from the noble Earl.

The Government acknowledge that there is no quick solution to the manpower problems facing the Defence Medical Services. Nevertheless, the Government believe that the measures being taken as a result of the Strategic Defence Review, combined with our new strategy for the Defence Medical Services, provide the basis for ensuring that the Armed Forces continue to receive the high quality medical support they both need and deserve.

        House adjourned at twenty-nine minutes before ten o'clock.

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