asked the Secretary of State for Social Services what representations he has received about the new scale of charges for National Health Service dental treatment.

We have received representations from a number of hon. Members, the British Dental Association and members of the public relating to the recent increase in charges and the changes in the system of charges.

Will the Minister confirm that the British Dental Association is extremely concerned about the confused, complex and extremely expensive structure of dental charges that he has imposed on its members? Will he also confirm that a young employed person with a diseased tooth will have to choose between paying £3.30 to have it out or £26 to have it filled? Will that contribute to good dental care?

There will be no administrative problems in the new arrangements, and what we have introduced is fair as between patients. I recently met representatives from the British Dental Association, who said that they would put proposals before me for improving the structure of charges still further, and I said that I would look at them carefully. It has always been cheaper to have a tooth out than to have treatment, but I am glad to say that the number of teeth being extracted is steadily falling as people steadily make more use of the better parts of the service.

Will my right hon. and learned Friend confirm that increased charges over the years have led to more people having more dental treatment and to improved dental health? Secondly, will he confirm that he will take rigorous action to pursue the exercise already undertaken by family practitioner committees to root out abuses of the system, whereby a minority of dentists boost their income by unnecessary treatment?

My hon. Friend is right. All the increases in charges have not deterred patients from using the service, and the number of courses of dental treatment in England and Wales has risen from 28·5 million in 1979 to 32·6 million last year. I agree with my hon. Friend that his last point is important. The British Dental Association also would like to see steps taken against that minority of dentists. It is encouraging FPCs to do as he asks, and is to set up a committee to inquire into unnecessary treatment.

Has consideration been given to areas such as mine where dentists have not been available on some islands for a number of years, and therefore dental hygiene is far behind what it should be? Is he aware that people there will be faced with charges of up to £115 for remedial work as against having all their teeth extracted? How can that help such people?

I am sure that my right hon. Friend the Secretary of State for Scotland is doing all that he can to improve the distribution of dentists, just as we are trying to do constantly in England. The structure of charges has been changed only to make it fairer to patients. The practice of raising charges as a contribution towards the cost of the service has been the policy of successive Governments for many years. I do not believe that any Government will change it.

Is my right hon. and learned Friend aware that his assurance that he will be prepared to review the structure of charges if there is evidence that it will be necessary is widely welcomed? Will he also give an assurance that if there is evidence that the heavy cost is deterring people from seeking treatment he will review the system to ensure that there is no deterioration in the nation's dental health?

I have previously invited the BDA to put to me its ideas on the structure of charges and I am glad that it has agreed to do so. We will consider its suggestions carefully because we certainly need a fairer system.

Is the Minister aware that the latest round of increases——

Tell us about mortgages.

Order. This has nothing to do with mortgages.

Is the Minister aware that the latest round of dental charge increases is so large that millions of people will be forced for the first time to pay the full commercial cost, even for relatively routine treatment? Many people who previously paid only £14.50 for such treatment will now have to pay £40. Is he aware that he must be exceedingly gullible if he thinks that that will not be a deterrent to many people, especially as many practitioners in the BDA have already made clear their view that increases of this size will set dental health back a generation?

I will not make my usual remark about the hon. Gentleman going over the top and talking nonsense, but he seems to overlook the fact that 60 per cent. of all visits to dentists are free and that we are talking only about charges for those who can afford to pay them. On average, even those who pay, pay only about 60 per cent. of the cost of treatment. Therefore, it is nonsense to say that people are paying the full commercial cost. It is not true to say that we have altered the system in that respect. I wish that I understood clearly where the hon. Gentleman stands. I shall read his policy document with care. No doubt he plans to abolish dental charges, among other things, because of the revenue that he expects to raise from abolishing tax relief on mortgages.

asked the Secretary of State for Social Services what has been the change in the number of blood donors since the recent publicity about acquired immune deficiency syndrome.

Figures for recent months on the number of donations are not yet available. However, inquiries suggest that there has been some reduction in donations in the past few months. It is not possible to distinguish how much of this is due to publicity on AIDS and how much to other factors such as the bad weather experienced earlier this year.

Does the Minister agree that there is an acute shortage of blood for the transfusion services and that at least some of the shortage is caused by people's reluctance to go to blood transfusion centres for fear of being refused the chance to donate blood because of AIDS? Does the hon. Gentleman agree that he should take further action to encourage more people to give blood?

Preliminary figures show a drop in donations of 5 or 6 per cent. in the first three months of this year. People should not be inhibited from donating blood, because there is no risk of their contracting AIDS. All the equipment is sterile and it is all disposed of immediately after use; it is used only once. We are spending £250,000 in the current financial year to encourage more people to be blood donors.

Does my hon. Friend agree that those of us who are blood donors have a responsibility to give a lead? Can he assure us that the HTLV 3 test, which is promised for July, is still on target, because that will give great hope to the regional blood transfusion authorities?

Yes, we hope to have a screening test within a few weeks.

Will the hon. Gentleman encourage the regions to send blood to the Elstree fractional unit to get the better and safer use of blood?

That is a very good idea, especially in the run up to the opening of the new blood products laboratory at Elstree, which is on target for completion in January 1986 at a cost of £35 million.

asked the Secretary of State for Social Services if he will make a statement on the procedures and machinery by which he monitors the implementation by social services authorities of the Chronically Sick and Disabled Persons Act.

Prime responsibility for monitoring the implementation of the Act rests with local authorities themselves. They make regular returns, however, to the Department on certain services provided under the Act. The Department obtains further information on levels and standards of provision for disabled people from a number of sources, including research studies and the work of the Department's own social services inspectorate.

Is the Minister aware of the increasing concern among local authority leaders, not least the Conservative leader of Hillingdon, that in obeying the law on rates they are being forced to break the law passed by this House to help the disabled and their families? Are the Minister's right hon. Friend and the Secretary of State for the Environment prepared to meet those leaders urgently to discuss their anxieties? Will he say whether it remains Government policy that the disabled on supplementary benefit should not be charged for their home helps?

I shall take the three questions separately. I shall certainly draw the attention of my right hon. Friend the Secretary of State for the Environment to the right hon. Gentleman's request. My right hon. Friend the Secretary of State for Social Services will have heard the right hon. Gentleman. On home helps, Ministers have consistently made it clear that they would prefer those on supplementary benefit, whether disabled or otherwise, not to be charged. On resources, it is simply not my view that local authorities which practice proper policies of economy in administration need fail to fulfil their statutory duty, whether to the disabled or to others.

I find that a disappointing and unsatisfactory answer. Does it not show that the Minister has no real understanding of the problems of local authorities in trying to implement the Act, because of rate capping and penalties? Is he not ashamed to be a member of a Government who expect chronically sick and disabled persons to pay a disproportionate price for the Government's monetarist policies? Will not the electors in the forthcoming shire county elections take that into consideration and vote Labour?

The hon. Gentleman gave a fairly good clue to the purpose of his question in his last sentence. The Government have consistently made it clear, and I repeat it today, that the needs of the disabled under the Act are something to which we hope local authorities will give proper priority. If they make sensible choices, I have no doubt that they can fulfil their responsibilities under the Act.

Does the Minister accept that no local authority would admit to contravening the Act, but that all our experience shows that the level of service provided under the Act is deteriorating through lack of resources? Does he further accept that there is a need for a permanent register, regularly updated, so that there is an objective measure of those in need and the extent to which that need is being answered?

The hon. Gentleman knows that local authorities have a duty to discover the numbers and needs of people in their areas. We have tried from the outset to help them to fulfil that duty, and I have no doubt that most local authorities succeed in fulfilling it. I shall, of course, take note of the hon. Gentleman's suggestion, but, frankly I think that it would lead to a great deal of unnecessary, bureaucratic and wasteful expenditure.

asked the Secretary of State for Social Services by how much productivity has increased in each region of the National Health Service since the end of 1980.

There is no simple measure of productivity. Nationally, the number of inpatient and day cases treated in hospitals in England rose by 7.7 per cent. between 1980 and 1983, while expenditure measured in cost terms rose by 2.3 per cent. I shall, with permission circulate details by region in the Official Report.

Does my right hon. and learned Friend agree that probably the best way to judge the performance of a region or a district is to publish the figures of each region and district so that they can be judged against each other?

I agree with my hon. Friend. I am sure that we can do what he suggests. I can certainly give him his own region's figures. We increased spending on the north-west by 4 per cent. over and above inflation between 1980 and 1983. I am glad to say that that region increased the number of inpatients treated by 10 per cent. in the same period, which shows productivity as well as increased spending.

Why do the Government insist on forcing the West Cumbria health authority to go out to tender on its services when the unions have offered a £100,000 productivity saving if their tender is accepted? Why does the Minister not accept that? Does he not realise that if the authority is forced to make further savings, support for patients will be reduced, standards will fall and the pay and conditions of health workers will be reduced?

Throughout the NHS we are insisting that we do not spend any more than is necessary to maintain the standard of support services, because in that way we can spend as much money as possible on improved patient services. I cannot believe that the West Cumbria health authority, any more than any other authority, cannot find ways to improve its patient services. I do not believe that West Cumbria cannot think of anything on which it wants to spend money apart from accepting a second-best bid on its support services.

Does my right hon. and learned Friend agree that in the past we have tended in the Health Service to be obsessed with the measurement of inputs, such as the numbers of nurses, doctors and so on? Does he further agree that it is time that we established targets more in relation to outputs, such as the number of patients, particularly in relation to costs? May we have those figures, not just for regional health authorities, but for district health authorities as well?

I wholeheartedly agree with my hon. Friend. We are constantly lobbied by people who go on about the amount we spend and the numbers we employ. All the figures in those respects are satisfactory. The Health Service is about patients. A dramatic increase is taking place all the time in the numbers of patients treated in and out of hospitals. That is the success of the service, and the attention of the public should be drawn to that aspect.

I note the Minister's comment about it being hard to find a definition of productivity. Is he prepared to examine the possibility — [HON. MEMBERS: "Speak up".] Oh, children, shut up. [Interruption.]

Order. Mr. Meadowcroft.

Does the right hon. and learned Gentleman agree that it is time for a follow-up to the Black report to take into account the levels of health among different sections of the public in different areas of the country so as to determine whether we have or do not have a healthier nation under the present Government?

By all the indicators of health care, we compare well as a nation with other countries, including those which appear to spend much more than we do in this area. The trouble with the Black report was that it began by analysing differences in health standards— which, I agree, are important — but then came up with some extremely expensive propositions in the social security sphere which it seemed to imagine would provide the answer. We are redistributing resources between different parts of the country to try to iron out inequalities, and we will continue to seek to identify the most pressing priorities in terms of health care.

Is my right hon. and learned Friend surprised to hear that when I visited the Oldham general hospital laundry last week, I discovered that 54,000 articles of clothing are processed there each week? Since the Conservatives came to power the hospitals have achieved much greater efficiency. Does he agree that that is the direction in which we should be moving, so making money available for patient care?

I am sure that my hon. Friend brought considerable pleasure to those at the Oldham general hospital laundry on the occasion of his visit, and I am sure also that he took the opportunity to congratulate them on what they have achieved. I agree with my hon. Friend that we need to point out to those involved with the NHS just what they are achieving by means of increased efficiency and better patient care. Those facts should also be brought to the notice of the general public.

asked the Secretary of State for Social Services if he is satisfied with the present health education services; and if he will make a statement.

The health education service is an important element in our efforts towards promoting good health and preventing disease. Most health districts now have access to the services of health education officers, and in their strategic planning regional health authorities are increasingly recognising the role of health education. In support of this development we have increased our grant to the Health Education Council from £4·5 million in 1979–80 to £9·8 million in the current financial year, an increase of 39 per cent.

Is the Minister aware that, in spite of the laudable work that is being done by the Health Education Council, health promotion is not making the impact that it should be making? Does he agree that a substantial improvement could be effected by the use of joint initiatives, for example with industry or general practitioners? Will he encourage that type of initiative and make available the necessary resources to put it into operation?

We have made considerable resources available. We have had a considerable impact over a whole range of areas concerned with prevention. I take the hon. Gentleman's suggestions seriously. They are constructive and I want to examine them. They are much more constructive than the dotty suggestion of the hon. Member for Oldham, West (Mr. Meacher) to put VAT on sugar. Presumably that will lead to a pledge that a future Labour Government will impose VAT on food.

I welcome the increase in the Government's support for health education. Does my hon. Friend accept, however, that more could and should be done, bearing in mind that at about £10 million, only a modest amount of money is being spent on it, particularly as the advertising budgets of the drink and tobacco industries amount to more than £200 million a year?

The amount of almost £10 million is simply the sum that goes to the Health Education Council. A substantial amount of money is spent by regional and district health authorities on health promotion. Increasingly, regional health authorities are integrating health promotion into their regional strategic plans.

Are the Under-Secretary of State or his ministerial colleagues planning to take any steps to examine more rigorously the role of the tobacco industry in terms of promotion, advertising and sports sponsorship?

Sports sponsorship is a matter for my hon. Friend the Under-Secretary of State for the Environment, the hon. Member for Sutton and Cheam (Mr. Macfarlane). The present agreement restricting advertising — it is a voluntary agreement — runs out in about March 1986. Negotiations on that agreement will begin shortly.

Is my hon. Friend satisfied that sufficient financial resources are available to deter people from smoking in excess of what is supposedly the average amount?

We recently gave an extra £500,000 for a programme devoted entirely at smoking by women. Recent figures show a considerable decline in the sale of cigarettes, from 137 million in 1977 to 98 million last year.

asked the Secretary of State for Social Services whether he intends to introduce regulations governing the rights of volunteers and their dependants undertaking drug trials.

We have no plans to do so at present.

The Minister will be aware of the case of Philip Jones, although he may not be able to comment on that specific case. Is there not a case for having regulations to ensure that drug companies pay a bond or take out some sort of insurance against the need to pay compensation when poor people are induced to volunteer because of the small rewards offered by the drug companies?

Obviously I cannot comment on the Welsh case, because we are still awaiting an inquest. I was concerned about the death about a year ago of a volunteer in Dublin and answered questions on that subject from the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) and other hon. Members. The rules are being reviewed by the Royal College of Physicians. I hope that the Medicines Commission will examine the results of the review and advise us whether improvements are needed. The industry's present code allows for compensation to be paid if trials have harmful results. Obviously, no one knows yet whether this Welsh case arises from a trial.

Is the Minister aware that he cannot shrug off responsibility just like that? There is a need for an independent assessing body to ensure that there is full information about all these drug trials and that the volunteers know about the risks involved and the nature of the drugs. That is very important.

With respect, I do not think that I am shrugging off responsibility. The Medicines Commission is an independent body which has already advised us that it does not think that legislation is required. It will look at the updating of the guidance provided by the various bodies. I agree with the right hon. Gentleman that volunteers must be genuine volunteers, who are fully warned about what they are doing. They must not be induced by financial offers to participate in trials.

Following the tragic death of Philip Jones, is the Minister aware that the pharmaceutical industry's guidelines are repeatedly breached because vulnerable groups such as the unemployed are regularly used for these experiments? Is the hon. and learned Gentleman aware that the ethical committees which the drug companies have set up to supervise such experiments often comprise their friends and associates? Is the hon. and learned Gentleman aware that no monitoring of disablement or injury caused by these experiments is kept and that drug companies from abroad are flocking to this country for this purpose, precisely because this sensitive area is unregulated? Will the hon. and learned Gentleman, as a matter of urgency, assure the House that he will introduce statutory regulations to govern this key area?

I am not aware of any of those aspects. I should be interested to know whether there is any evidence to support any of the hon. Gentleman's assertions. I would certainly take a serious view of any suggestion that the guidance was not being followed, that other mistakes were being made or that volunteers were being put at risk. Every organisation that has examined this matter, including the Medicines Commission and the Royal College of Physicians, has said that statutory regulation is not required.

asked the Secretary of State for Social Services what recent representations he has received concerning the scope and level of prescription charges.

Since 1 January this year we have received 152 letters from Members of Parliament and 214 from members of the public about the scope and level of prescription charges.

Is the Secretary of State aware that the people who suffer chronic ill health, who are not covered by exemptions and live just above the poverty line cannot afford the increase in prescription charges? Is the right hon. Gentleman aware that in areas such as Merseyside, where there is a high number of chronic illnesses, this is a cruel tax on ill health and a prescription for more pain and suffering?

I do not accept that. It would be more convincing if the Labour party had not reversed its position. It is no longer committed to the abolition of prescription charges. That has been made clear by the hon. Member for Oldham, West (Mr. Meacher). I am sure that on this occasion he has checked his information with the shadow Cabinet.

Is my right hon. Friend aware that as the average prescription is even now subject to a subsidy of about 50 per cent. the only question on this issue is how much longer we can go on subsidising to such a large extent the relatively small number of people who pay prescription charges?

My hon. Friend is right. On average, the £2 prescription charge provides only 44 per cent. of the cost of the prescription. It must be underlined that 72 per cent. of patients do not pay prescription charges.

Will the Secretary of State acknowledge that one of the arguments used has been that prescription charges bring in money for the National Health Service? If that is the case, why did we have the appalling exhibition on television last week of a consultant reporting that a children's ward at Guy's hospital had to close down and that he was unable to use 20 beds for children who were critically ill? Why do all the arguments that the Secretary of State puts up about the National Health Service and the need for prescription charges result in the ruination of young children in Great Britain?

The logic of what the hon. Gentleman is saying is that if we take away the resources that come from charges there will have to be further reductions in the services provided by the National Health Service. At the moment, charges raise 3·2 per cent. of National Health Service costs. In 1969–70, during the previous Labour Government, they were providing 3·5 per cent. There is now no disagreement, in principle, between myself and the Opposition on the fact that there should be charges.

asked the Secretary of State for Social Services what is the annual cost of running St. Mary's hospital, Hampton.

The annual cost of running St. Mary's hospital, Hampton is approximately £276,400.

Are not those costs low in relation to the services that St. Mary's hospital provides, and which are greatly cherished in Hampton? Is my hon. Friend aware that there are strong feelings locally that those services should continue? May I bring a delegation to see him?

Those sums of money are low. My hon. Friend has already made me aware, by his powerful private interventions, of the great value set on that hospital by his constituents. Yes, of course, I should be happy to see a delegation led by him.

asked the Secretary of State for Social Services if he will seek to pay an official visit to King's college hospital, London.

I have at present no plans to do so.

Will the Minister direct his attention to the problems of the accident and emergency department at King's College hospital, which is the busiest in the south-east? Is he aware that the regional authority continues to deny funds to redevelop it and that when recently the department was able to save the life of PC George Hammond it had to shop around privately for body scanning facilities to save his life? Does the Minister not think that that is disgraceful? Will he reverse the spending trend?

There is plainly always competition for funds between different units. There are body scanners in that part of London. There is one at St. Thomas's and one at Guy's. The Camberwell health authority chose to make arrangements with the Cromwell because, presumably, it is in its interests and those of NHS patients to have scanning done there. If an application for a scanner is made by the south-east Thames region, no doubt it will be considered in due course. The Camberwell health authority has also to concentrate upon improving other parts of its service. We must not allow highly publicised claims for items of equipment to divert the authority from its main priority.

Can my right hon. and learned Friend say what support his Department gives to King's College in its specialties, in particular its treatment of liver diseases?

King's is undoubtedly one of the major national centres for liver transplant operations, amongst other things. I am glad to say that the Government are making an additional grant of £132,000 from central funds this year for the work of the King's liver transplant unit.

The Minister mentioned the two National Health Service hospitals in the region that have CT body scanners. Is he aware that the reason why PC George Hammond had to be carted right across London to the private Cromwell hospital is that the waiting lists for scanners at the National Health Service hospitals are already full? As the King's district already lacks vital facilities, will he stop the further cuts that are being imposed on that district?

I am glad to say that PC Hammond received most excellent care and treatment at King's College hospital, and I would not say anything against that. I believe that he was carted across to the Cromwell hospital in front of the nation's press cameras because someone wished to campaign for an item of equipment at King's College hospital. The Camberwell health authority is right to concentrate, as it is doing, upon developing services for the mentally handicapped and ill. That is the first priority in that district.

asked the Secretary of State for Social Services what further discussions he has had with representatives of the medical profession about a scheme for prescribing unlisted medicines in exceptional circumstances.

We have had several meetings with representatives of the medical profession to discuss a mechanism which would allow drugs not generally available at National Health Service expense to be prescribed in exceptional circumstances. Those discussions are making good progress and I hope that we can soon reach agreement.

Ought not the scheme to have been in place from the beginning of the operation of the limited list, and is it not wrong for the Minister to put the onus on the BMA when the state of his relations with that body are of no interest whatsoever to that minority of patients who may need drugs that are not on the list?

I think that it was up to the BMA to start the talks. There is no way that I can start discussions with the medical profession unless it is prepared to have them. Even the Liberal party must accept that. We started discussions on the appeal mechanism as soon as was possible after the regulation was passed by the House. Progress is being made and I am optimistic that we shall soon have an agreement.

Is it correct to say that some doctors appear to be going out of their way to circumvent the provisions of the scheme? Will my right hon. Friend give an undertaking that he will do all that he can to ensure that, consistent with patients continuing to receive the drugs that they require, the anticipated savings will be achieved?

Yes, I can give my hon. Friend an assurance on the last point. There is very little evidence that any abuses are taking place, but clearly we shall keep the position under review.

Is the Secretary of State aware that serious concern and distress are being experienced by many patients because of the limited list? Would it not have been far better for him to await the outcome of his discussions and the establishment of an appeals machinery before taking the action that is now causing concern among doctors and patients?

I do not accept that. We announced the proposals in November. That gave time for discussions and consultation with the public. It was entirely the responsibility and decision of the medical profession not to start those talks. As I have said, those talks have now taken place and I am optimistic that they will have a successful outcome very quickly.

Is my right hon. Friend aware that not all doctors are going out of their way to frustrate these arrangements and that, in the case of the chronically sick, those who are permanently ill and need pain-killing drugs, many doctors are complaining—certainly to me in my constituency — that they are precluded from prescribing what they believe to be clinically necessary?

Nonsense.

It is not nonsense in south-east Essex. What arrangements is my right hon. Friend making for greater flexibility in this matter so that patients' needs can be met?

I agree entirely with my right hon. Friend that there is no evidence that doctors are seeking to abuse this system. The whole purpose of the talks that we are having is to meet any legitimate concerns that there may be. I think my right hon. Friend will accept and agree with me that in the first stages this new system has gone remarkably well.

Can the Minister inform us whether it is now legal and legitimate for general practitioners to provide patients with medications on the so-called blacklist if they put down on the prescription form a list of the generic contents of that particular medication?

In one or two cases that is clearly the case, as with the ingredients of a distalgesic. That is the case and always has been.

asked the Secretary of State for Social Services if he will make a statement on the facilities for open heart surgery in the Manchester area.

Open heart surgery in Manchester is provided at Wythenshawe hospital and Manchester royal infirmary. In the year just ended a total of 1,130 open heart operations were carried out in Manchester, 23 per cent. more than in 1983–84. The North-Western regional health authority is developing ambitious plans in its new strategy to increase heart surgery cases, and a substantial increase is planned in the next 12 months.

I recognise the considerable advances that have been made in open heart surgery in the Manchester area, but may I urge my hon. Friend to impress upon the North-Western regional health authority the importance of trying to do even more of that vital work over the next decade?

The whole country has shared in the success which the North-Western regional health authority has seen over the past five years. For example, open heart surgery has more than doubled and coronary artery bypass grafting has gone up by 160 per cent. I shall impress on the regional health authority the fact that we expect to see that high priority maintained.

May I assure the Minister that the medical profession in Manchester is far from satisfied with heart surgery operations in that area. Consultants and general practitioners are worried and distressed about the long delays, and the suffering that has been caused as a result. Is it not a fact that throughout the country there are increasing delays for people needing heart surgery? May I also tell the Minister that today my own union, the Amalgamated Union of Engineering Workers, forwarded a letter to me saying that in the Coventry area one of our members has now waited nine months——

Order. That is a bit wide of Manchester, I think.

It is still relevant to heart operations. One of our members has been waiting nine months for treatment. What will the Minister do about that?

I do not know about the AUEW in Coventry. What I do know is that there is a record number of open heart operations in Manchester, and the health authority is making a substantial, planned and proper increase in the number of operations in the coming 12 months.

Is it the case that my hon. Friend is, perhaps, channelling too many funds to Manchester rather than to Guy's hospital in south-east London, as cited in the television programme mentioned by the hon. Member for Bolsover (Mr. Skinner) a few moments ago, or is it a fact that the South-East Thames regional health authority is not efficient?

Guy's hospital is also rather a long way from Manchester. However, what I can say about that hospital and that regional health authority is that we estimate that the authority could be saving as much as £1 million per annum by putting out its services to competitive tender. It is refusing to do so. That is why it is in financial trouble.

Will the Minister tell the House how many patients from the Manchester area have had to be taken to London for their heart operations in the past year, and what was the total cost?

I do not know the exact figures. I shall write to the right hon. Gentleman. However, I can tell him that in the past year the number of open heart operations has gone up by a quarter in Manchester, and there are substantial plans for real and sustained improvement in the level of services in the city.

asked the Secretary of State for Social Services if he intends to bring forward any proposals regarding the future of the state earnings-related pension scheme.

Financial provision for retirement, including all aspects of the state pension scheme, is being considered as part of the current social security review. Any proposals for change arising out of the review will be published as soon as possible.

Is the Minister aware that if there were any change in the scheme it would cause tremendous disapointment and shock for literally millions of people who depend on the state pension scheme in order not to live in poverty? Why does the hon. Gentleman not now take the opportunity to confirm that the scheme will remain in existence?

The Government's concern is to make sure that there is proper financial provision for people in their retirement, with the aim of ensuring that fewer than in the past have to depend on means-tested benefits. That is our strategic aim. It is with that in mind that we shall draw up our policies.

Will the Minister confirm that any proposals either to abolish or to weaken the state earnings-related pension scheme will go completely contrary to the assurances given by the Prime Minister during the last election campaign and by his right hon. Friend the Secretary of State when the reviews were set up?

Both my right hon. Friend the Prime Minister and my right hon. Friend the Secretary of State have made plain time and again this Government's commitment to looking after the interests of retired people. That is our strategic aim, and that is what we shall seek to maintain in the review.

asked the Secretary of State for Social Services if he will make a statement on the progress of computerisation within the National Health Service.

Computers are already in extensive use in the National Health Service. We are currently developing with health authorities a strategic approach to the use of information and available technology aimed at further improving the management and delivery of health services.

Will my hon Friend take into account the need for substantial monitoring of the development and use of computers so that we can see the tangible benefits as soon as possible?

Capital investment in computerisation in the NHS is running at approximately £100 million. There is evidence of that investment in my hon. Friend's area of north Warwickshire, where the district health authority is funding four practices, which cover about 40 per cent. of all patients treated by family practitioners in that area.

asked the Prime Minister if she will list her official engagements for Tuesday 16 April.

This morning I had meetings with ministerial colleagues and others. In addition to my duties in this House I shall be having further meetings later today. This evening I hope to attend a state banquet in honour of President Banda.

Is my right hon. Friend aware that millions of home owners throughout the country are appalled at the proposals of an Opposition Front Bench Member that a Labour Government would abolish mortgage interest tax relief? Will she confirm that her Government remain committed to our present policy of mortgage interest tax relief?

I saw the Labour party plan for abolishing mortgage tax relief. I confirm that, so long as I am at the Dispatch Box, mortgage interest tax relief will be a policy of the Conservative party.

Since the Chancellor of the Exchequer has told the House that inflation is likely to rise to 6 per cent. later this year, does the Prime Minister still agree with the target of 3 per cent. of which she spoke in the far east? When will she have a target for reducing unemployment?

I believe that inflation can be reduced further. My right hon. Friend the Chancellor of the Exchequer is right to say that it will increase slightly before it decreases, but we must pursue policies to reduce inflation. I remind the right hon. Gentleman that 3 per cent. is still inflation.

Does my right hon. Friend agree that commitments made to the working miners during the recent coal strike both in this House and by the National Coal Board must be honoured? As some of those miners seek transfers because of harassment and intimidation, does she agree that the promises made must be fulfilled speedily and sympathetically?

Yes, I am anxious that the working miners should be fully and properly looked after. My hon. Friend will notice that Mr. MacGregor issued a firm statement the other day which showed the action that he had taken and made it clear that wherever he was presented with firm evidence it would be followed up immediately.

How many extra flights into Manchester international airport will result from the Prime Minister's visit to the far east? Regarding her visit, does it help our country to talk about seeing off— [HON. MEMBERS: "Yes."] — a section of Britain's working people, who were recently described by the Earl of Stockton as the finest people in the world?

In the first part of the question, I think that the hon. Gentleman was referring to a possible application by Singapore International Airlines. Talks on that will be starting shortly. — [Interruption.] I am referring to Singapore. We dealt with the Malaysian matter earlier. I believe thatmore flights into Manchester are required from Singapore.

"Then came the big one—the strike of coalminers. That is in the public sector. But the great achievement of that was not only that some miners stayed working, not only that we saw it off after a year—"

"The great achievement of that was not only that some miners stayed working, not only that we saw it off after a year, but that steelworkers were not going to come out in support, nor were the railway workers going to come out in support and the docks, of which most are private, were brought out under false pretences for about a fortnight and they got back to work.

So may I cheer you up a bit. We resisted that year-long strike and the two outstanding achievements were that among trade unionists in Britain not one trade union gave support because they were learning the facts of life."

asked the Prime Minister if she will list her official engagements for Tuesday 16 April.

I refer my hon. Friend to the reply that I gave some moments ago.

Will my right hon. Friend ignore the humbug from the Opposition about her very successful far eastern tour? Was her attention drawn during her absence to the evidence of ballot-rigging in the election for the leadership of the Transport and General Workers Union? If we want responsible and representative leaders for our great trade unions, should we not insist on mandatory postal balloting?

That was considered during the passage of the Trade Union Bill of 1984, which comes into force on 1 October this year. My hon. Friend will be aware that for some unions, such as the National Union of Seamen, postal ballots would not be appropriate. There is, however, a presumption in the Act that a postal ballot will take place, and if there is not to be a postal ballot a secret ballot must be carried out at the workplace or somewhere more convenient. There are very stringent conditions attached—everyone must be able to vote in secret and without interference or constraint, and if any member is dissatisfied with the way in which the ballot is conducted he can apply to the Certification Officer with his complaint and request a postal ballot.

As Britain's share of world manufactured trade has dropped by 20 per cent. in the six years during which the Prime Minister has held office, does she agree that it would now be best for everyone if she concentrated her attention on policies for production and sales promotion instead of on trips for self-promotion?

If the right hon. Gentleman is really interested in selling goods, which I doubt, why does he support strikes which have a devastating effect on Britain's reputation? He supports the lot. And why in the world does he not recognise that if we are to get more jobs we must get our unit labour costs down? Neither of those facts will he recognise.

Has the Prime Minister not yet learnt that one of the best ways to reduce labour costs and to increase our export performance is to sponsor and encourage policies for investment, design, training and employment, which would also have an effect on labour relations? Why does she not introduce and encourage such policies instead of dashing around all over the place like an egotistical flea in a fit?

Investment in assets in Britain was at an all-time record last year. I held the first design seminar at Downing street, involving those engaged in design, that has even been held. We have the best training system ever known in this country. That is my answer to the right hon. Gentleman.

Discarding the absurd remarks of the Leader of the Opposition, and acknowledging the success of my right hon. Friend's visit to the far east, may I ask my right hon. Friend now to reveal her itinerary for the Whitsun recess?

I am grateful to my right hon. Friend. My destination for Whitsun has been fixed for some time; it is Chequers.

Will the Prime Ministers tell the House whether, after her visit to Sri Lanka, she does not now believe that it would be better for Britain not to export arms to that country, in view of the oppression of minorities there, and that the service training agreement with the Sri Lankan armed forces should be ended?

Sri Lanka has a terrorist problem. The hon. Gentleman will know that the Conservative side of the House believes that terrorism must never be allowed to win. Any applications for arms are dealt with specifically, and they are not usually revealed.

asked the Prime Minister if she will list her official engagements for Tuesday 16 April.

I refer my hon. Friend to the reply that I gave some moments ago.

During her busy day, will my right hon. Friend find time to consider who are more likely to create real, lasting jobs—those who stay at home, carp, and make cheap propaganda points, or those who go to the far east and create the climate that will produce British business and orders?

I thank my hon. Friend. I believe that what the Labour party could not stand was the outstanding welcome that we received on the tour wherever we went.

asked the Prime Minister if she will list her official engagements for 16 April.

I refer the hon. Gentleman to the reply that I gave some moments ago.

Despite the inadequacies of some of the youth training schemes, does the Prime Minister not agree that the calls by some irresponsible members of the Labour party for young people to come out on strike and to leave their schools on 25 April is mischievous and irresponsible, and an attempt to use young people as cannon fodder?

I understand that that is the action which the trade union rights group proposes to take in Liverpool on 25 April. I deplore that politically inspired and counter-productive action. It is directly against the youth training scheme, which is designed to help young people to acquire more skills and better training in order to help them to get jobs. The action is totally inspired by the extreme Left wing of the trade union movement.

asked the Prime Minister if she will list her official engagements for 16 April.

I refer the hon. Gentleman to the reply that I gave some moments ago.

Will the Prime Ministertell the House what decisions her Cabinet colleagues made in her absence from which she will dissociate herself when she next goes abroad?

The hon. Gentleman will be relieved to know that there were no Cabinet meetings in my absence.

asked the Prime Minister if she will list her official engagements for Tuesday 16 April.

I refer my hon. Friend to the reply that I gave some moments ago.

Has my right hon. Friend had a chance to compare the statements on immigration made by the right hon. Member for Manchester, Gorton (Mr. Kaufman) with her own Government's policies? Does she agree that the right hon. Gentleman's statements are irresponsible, to say the least?

Yes, I saw the pledge by the Labour shadow spokesman to repeal the Immigration Act 1971, which he said was — [HON. MEMBERS: "Reading".] I am sorry; I am looking at what the right hon. Gentleman said. It was a deplorable pledge, which will give cause for alarm to a great many people. I note that the right hon. Gentleman proposes to repeal the 1971 Act, which was operated by the last Labour Government throughout their whole period of office, from 1974 to 1979.

asked the Prime Minister if she will list her official engagements for Tuesday 16 April.

I refer the hon. Gentleman to the reply that I gave some moments ago.

Does the right hon. Lady agree that it is utterly undesirable for someone with a known Nazi past, who has been active in Nazi organisations, to be employed as a civil servant? Was it known when he was appointed that he had a Nazi record and had served a term of imprisonment for Nazi activities?

I believe that the hon. Gentleman is referring to the employment of a civil servant in the Department of Trade and Industry. Inquiries are proceeding and my right hon. Friend the Minister for Trade will make an announcement as soon as possible.