More than 20 medical secretaries have volunteered to lose their jobs in a shake-up in how hospital notes are typed up. In total, 39 posts will go when a new remote medical transcription service, which will see notes typed up in India, is phased in.

A spokesman for the East and North Hertfordshire NHS Trust said that UK-based firms Alden and DictateUK will provide the service, using staff working in India. The move is expected to save the trust £800,000 a year.

Danny Mortimer, director of human resources, said: "The responses from our medical secretaries and consultants during the consultation have been constructive and enabled us to fine tune our plans.

Mr Mortimer said the change would also improve standards. "Both companies will provide us with a highly professional service that will work very effectively, based on a number of set quality and security safeguards being in place," he said.

"So not only will patients' confidentiality be maintained at all times, letters dictated by our doctors will be typed up promptly ready for checking.

"We believe that at a significantly reduced cost, this new service will result in as good a service as is the case currently.