To ask the Secretary of State for Health what subjects have been raised with him by doctors making representations on the proposals for their new contracts.

To ask the Secretary of State for Health if he will make a statement on the current situation in the negotiations on general practitioners' contracts.

To ask the Secretary of State for Health what progress has been made in negotiations on general practitioners' contracts.

Discussions on the new contract have now lasted for more than 12 months. I last met the General Medical Services Committee negotiators on 20 March. In the light of the discussions my officials are now preparing amendments to the relevant NHS regulations and to the statement of fees and allowances, on which they will be consulting the General Medical Services Committee negotiators. A conference of local medical committees is being held this week and the negotiators will no doubt consider whether to seek any further meetings with me in the light of the outcome of that conference.

Will my right hon. and learned Friend confirm that in his future negotiations and deliberations on this subject he will take fully into account the representations made by many Conservative Members following meetings with their doctors, who have expressed concern about the contract? Will he also take this opportunity to put at rest the minds of the many patients who have written to me and my hon. Friends about the effects of the contract and assure them that the principles of the National Health Service will be maintained as a service free at the point of consumption with medicine supplied without let or hindrance because of budgets?

I am grateful to my hon. Friend and to other hon. Members who have informed me of the views of the practitioners in their constituencies. We have taken on board many of the present representations which have already been made in the course of the discussions and we will certainly take on board all constructive representations now. I agree with my hon. Friend that it is most unfortunate that, in the course of negotiating the contract, some doctors have gone out of their way to cause needless alarm to patients, because no threats to patients will arise from this.

Does my right hon. and learned Friend agree that there are 5,000 more doctors than in 1979, they are far better paid than ever before and the number of ancillary workers working for them has doubled, and therefore the disgraceful statements made in a pamphlet by the British Medical Association are often untruthful, alarmist and verging on the paranoid? Will he confirm once again that, under the proposed Health Service reforms, no patient will go without a comprehensive local health service, adequate drugs or appropriate treatment?

I agree with my hon. Friend. We now have more doctors than before. They are better paid and their average list sizes have gone down. That is why it is right to concentrate on a contract which rewards fairly those who carry the largest work loads and one which also encourages new services for patients, which we offer in the contract. In contrast, the leaflet produced by the BMA to which my hon. Friend referred, contains scurrilous nonsense. It is a long time since I have encountered a trade union which is prepared to spend millions of pounds of its members' money on spreading untruths among its consumers in that way.

In the light of a general practitioner telling an elderly constituent of mine that, under the new contract, he may not be able to treat her, will my right hon. and learned Friend emphasise the fact that the elderly will be well looked after under the provisions of the new contract?

Yes. If such an allegation has been made —and of course, I accept what my hon. Friend has said—it is totally untrue. The contract is so designed to give extra payments to those doctors who take on elderly patients. The contents of the new contract that we are discussing include new services which are expressly aimed at elderly people to ensure that they—particularly those over the age of 75—have more regular contact with their GPs. The contract is designed to improve services to the elderly. It is scandalous nonsense to claim that any elderly patient is threatened by it.

What representation has the Secretary or State received from women doctors? Does he not agree that the new contract could harm women doctors' practices, which tend to be smaller?

The contract proposals recognise explicitly the prospect for job-sharing. We also acknowledge the right for someone to have the full status of a principal when taking on part-time obligations. The contract is designed to encourage women doctors in general practice. An ever higher proportion of GPs will be women. The difficulties arise from the changes in basic practice allowance, not from the contract. They stem from the fear of some women that partners will not take on female partners unless the BPA is so constructed as to give all partners a financial benefit when a part-time partner is taken on. Women have no reason to be fearful of their colleagues' prejudice. Nothing in the contract would encourage that.

Are GPs to be cash-limited?

No they are not.

Does the Secretary of State accept that the only reassurance that he could give to National Health Service users would be to cease the stupidity of trying to transform doctors into accountants? The public's clear answer is that they want no part of this crazy scheme.

Doctors are independent contractors. It is my duty, on behalf of the patient, to negotiate a contract which rewards heavy work load and encourages good performance. The rest of the population are paid according to the work that they do and the standards that they attain. Many doctors can see no reason in principle why the same criteria should not apply to general practice. The result of the new contract will be an improved service for the patients, because the best and most go-ahead practices will be rewarded. We shall also introduce into the contract up-to-date services in disease prevention, health promotion, and closer surveillance of young children and elderly people.

Will my right hon. and learned Friend accept my thanks for putting at rest the fears of my 84-year-old constituent, who had been informed by his doctor that if this contract went through his doctor would no longer be able to visit him at home in a rural area?

The new contract will place the doctor under an express duty to keep in touch with the elderly patient and keep himself well informed of his home circumstances. By its capitation payments, the new contract will pay the doctor extra to enable him to carry out that new duty. I can only assume that if the doctor in question has put out such information, he has been totally misled by the information from Tavistock square.

Is it not the case that a patient receives better care if a GP has more time to spend with each patient? Is it not going in completely the wrong direction to give financial incentives to doctors to have as many patients as possible on their lists?

I quite agree that patients will wish to join practices that give them adequate time and care and, I hope, offer the new services, for which the new contract is an encouragement. With respect, the arguments about list sizes constitute a complete red herring, which has been put in the forefront of many of the discussions. Under this contract, there is no reason why anyone with an average size list should wish to acquire new patients. A doctor seeking to enhance his income would go for the new services and seek to hit the new performance targets. The hon. Lady and hon. Members on both sides of the House should not be misled by the simplistic argument that this is all about increasing list sizes. The new contract is aimed at raising the standards of general practice to the general public, and the best GPs will respond to that.

To ask the Secretary of State for Health how many representations he has received from members of the public about his White Paper "Working for Patients."

I have received well over 2,000 representations from members of the public, expressing a wide range of views. I shall take these into account as part of the process of implementing the proposals.

Can my right hon. and learned Friend estimate how many of those representations are based on complete inaccuracies? Will he join me in deploring the black propaganda circulating among so many of our constituents, and causing such fear and distress to the elderly? What further action can he take to reassure the British people that the White Paper will improve the Health service?

I regret to say that a proportion of the representations that I have received are indeed based on inaccuracies. They come from two main sources. One is the campaigning literature about the contract, which suggests that somehow the elderly will be turned away and that other damage will follow; the other is the Labour party, which is carrying on a private and eccentric campaign of its own, claiming that it is rescuing the Health Service from privatisation. I have never proposed its privatisation, and nor has any other member of the Government.

Surely the Secretary of State accepts that all the GPs who are responding negatively to his proposals —as the overwhelming majority are—are neither paranoid, to quote the hon. Member for Wyre Forest (Mr. Coombs), nor scurrilous, to quote the Secretary of State. They are genuinely concerned about the future of a service to which they have given their lives, and it is time for the right hon. and learned Gentleman to respond more sensitively to their representations.

Very few GPs, I think, would challenge my aims of improving general practice. Very few do not accept, for instance, that we should seek to attain World Health Organisation standards of vaccination for children and should not get cervical screening to a level of 80 per cent., which will help to tackle the biggest single avoidable cause of death among women in this country.

Are not so many GPs behaving as they are because they have been totally misled, misinformed and disinformed by their own leaders in the British Medical Association? Will my right hon. and learned Friend constantly try to fight off those lying attacks, particularly the claim that the aim of the review is to cut back expenditure in the National Health Service?

The Government have increased expenditure on the NHS more than any Government. I assure my hon. Friend—if she needs reassurance—that all our plans for the future are based on the expectation that expenditure on the NHS will need to increase in line with rising demands and changes in demography.

Is the Secretary of State aware that I have conducted a poll among all the doctors in my constituency, in which 47 voted against his proposals and three in favour? Is he aware that their letters were accompanied by impassioned criticism of his proposals? What notice is he prepared to take of their representations?

I am meeting thousands of doctors, and so are my ministerial colleagues. We are taking serious account of all constructive representations put to us. It is pointless to consider accounts of straightforward votes of the kind to which the hon. Gentleman has referred unless we know whether they concern the contract or the White Paper; if the White Paper, what part of it; and what proposals they are putting forward.

To ask the Secretary of State for Health how many patients were treated in National Health Service hospitals in the most recent year for which figures are available; and what were the comparable figures for 1978.

Between calendar year 1978 and fiscal year 1987–88 total annual in-patient cases for England increased by 23 per cent. from 5·4 million to 6·6 million. Over the same period, day cases rose by almost ½ million and out-patient attendances by over 2¾ million.

Does my hon. Friend agree that these figures provide the best evidence of the improvement and expansion of the National Health Service since this Government came into office because they show a substantial increase in the number of patients being treated?

The figures underline the success this Government have had, with a 40 per cent. increase in real terms in expenditure on the National Health Service. For the year just commenced, there is a £2 billion increase in resources.

Can the Minister comment on the waiting lists in the corresponding period and say what he will do about them?

Over the last 10 years, waiting lists have gone down by 8 per cent.—[Interruption.] True. Regarding the west midlands, waiting lists in my hon. Friend's constituency and the surrounding region have gone down by 19 per cent.

Is my hon. Friend aware that the South Glamorgan health authority has contracted out all its open-heart surgery to a private hospital in Southampton? This means that patients are getting speedy care absolutely free to the patients and at a lower cost to the National Health Service. Is that not precisely what we are trying to do in the White Paper?

There are many examples—arid doubtless there will be more—of good co-operation between the private and public sectors.

To ask the Secretary of State for Health what further representations he has received from doctors in rural areas about his National Health Service reform proposals in the "Working for Patients" document.

We have received a number of representations and will take them carefully into account in implementing our proposals.

Will the Minister give details of the people and institutions that he consulted before he produced his White Paper document and proposals, particularly those in relation to rural general practices?

I do not know whether the hon. Lady is referring to the White Paper or the contract. There were considerable discussions of the contract prior to its publication by the Secretary of State after no less than 12 months' negotiations with the doctors' representatives. That document includes most of the material about rural practices. The process of consultation has not yet ended. The Secretary of State has already made it clear that he and his fellow Ministers are meeting regularly with general practitioners, and we shall certainly bear in mind the points that they make on those issues.

General practitioners' income is to rely to a greater extent on capitation. Will this not mean that doctors in rural areas will be rather worse off as a result of the change and, in those circumstances, should not the rural allowance be left in place?

I do not believe that doctors will be worse off, because we intend to pay a rural supplement to recognise the particular problems of doctors in rural areas. There has been some concern because of the aged definition of "rural" used in some cases. Areas that are actually no longer rural have been benefiting from some of the rural payments. We believe that our policy will enhance the position of rural practitioners. All points to the contrary are being borne carefully in mind before we make our final decision.

I welcome that assurance, but is the Minister aware that there is great concern that the small rural practices which have been giving good service believe that they will be penalised under the new system? Will the Minister accept that the consultation time of 20 hours face to face in surgery may not really be a useful basis on which to work, especially when one allows for home calls?

In making that determination, we have borne home calls in mind but, as I have said, all points are being considered. In a number of cases rural practitioners have smaller lists, and to make allowance for that we intend to pay an enhanced capitation fee for practices between 500 to 1,500. In the exceptional circumstances of highly rural communities, where it is justifiable that the practitioner has under 500 patients, it might be possible to pay such a person under the inducement payment scheme, which recognises the exceptional problems of highly scattered areas. I hope that in that respect we shall ensure that rural practice is enhanced and not diminished by our proposals.

Will my hon. and learned Friend accept that in the rural areas the quality of medicine, and particularly the motivation of the general practitioners, has been very high, because the quality of life has encouraged good GPs to take up practice? There is nothing to the contrary in the Government's White Paper. Certainly the proposals we have for Scotland show clearly that all this is taken on board and we shall continue to enjoy this quality of service.

I warmly endorse my hon. Friend's remarks.

To ask the Secretary of State for Health if he will make a statement on the state of the National Health Service in Leicestershire.

Leicestershire has benefited substantially from the extra money that the Government have made available—almost £200 million this year to Leicestershire health authority compared with £177 million last year, which is a real terms increase of some 2·4 per cent. There has been a substantial investment in new and improved facilities, including a new community hospital at Coalville opened in 1988 at a cost of £3·3 million, and further phases of Glenfield general hospital and Leicester royal infirmary, which are due to open in August 1990 and July 1991 respectively.

Is the Minister aware that, despite those mythical millions, currently 16,000 Leicestershire people are on the waiting list, more than 1,000 of whom have been waiting for longer than one year? Is he aware also that in Leicestershire, it takes 12 months to have a hearing aid fitted after referral from a GP? The Leicester royal infirmary has overspent its budget by £750,000 to protect local hospital services. Is the Minister further aware that last Friday I met general practitioners in my constituency, many of whom were lifelong supporters of the Conservative party, and many of whom said that their patients will suffer and in some cases die if the Government's doctor-capping proposals are brought into effect? When will the Government defend the National Health Service rather than destroy it?

There can be nothing mythical about the work being done at Glenfield and at Leicester royal infirmary, which will result in 700 new beds at a cost of more than £30 million. There can be nothing mythical about the fact that in the years 1982–86, some £47 million was spent on capital works in that district. However, there was something mythical about capital spend in the late 1970s under the Labour Government, when only £1 million was spent in 1978–79. We have increased that figure tenfold every year.

Is my hon. and learned Friend aware that Rutland people warmly welcome the offer of my hon. Friend the Under-Secretary of State for Health to visit Oakham and—in view of Leicestershire health authority's regrettable decision to close Oakham maternity unit—to talk to people there about rural services? Can an early date be set for that visit?

My hon. Friend the Under-Secretary of State is for ever using his Away Day ticket to travel to such meetings. It is a regrettable fact that when there is massive capital expenditure on major facilities in a district such as Leicestershire, it is necessary also to close smaller facilities. That is particularly so with maternity units, where the necessity to continue reducing perinatal mortality means that larger maternity units are needed. I understand the stress and difficulty that such decisions sometimes cause local communities, which is why we have a system in which community health councils can object and in which, ultimately, Ministers can make a separate determination as to whether a closure is justified.

To ask the Secretary of State for Health if he will now make public details of performance-related payments made to managers in the National Health Service and state in each case why such payments have been made.

No, Sir.

Does the Minister accept that the 100,000 Wakefield people who petitioned against the proposed closure of Snapethorpe hospital in my constituency have a right to know whether a district health authority general manager having a salary of £35,000 per year will receive a cash bonus for achieving the closure of that hospital?

Snapethorpe hospital has not had a patient in it since 1984. I know that the hon. Gentleman has been pursuing a vendetta against the district general manager concerned but he cannot blame that manager for obeying the instructions of the health authority rather than those of the hon. Gentleman.

To ask the Secretary of State for Health what progress is being made with the plans to create 100 new posts for consultants.

On 13 April we wrote to all regional health authorities setting out the criteria and inviting them to "bid" for those posts. The posts will be targeted on the six specialties that account for 80 per cent. of patients who have waited more than one year for treatment, but bids can be made for any specialty. We expect to inform regions by October which of their bids have been successful. The first new consultants under the scheme could be in post by the end of the year.

I am grateful to the Minister for that helpful reply, which will be particularly welcomed by junior doctors. However, when it comes to considering the bids from the regions, may I ask him to look very carefully at west Norfolk, where expenditure on the Health Service has risen very sharply in real terms, but where the growth of population is among the fastest in the country?

My hon. Friend makes two good points. I certainly agree with what he says about his region. It is important to bear in mind not only the 100 new consultants proposed in the White Paper, but the massive expansion in the number of consultants proposed under "Achieving a Balance". The number of consultants in this country, which was 14,500 in 1987, will increase to 19,500 by 1998. That will increase the ability of junior hospital doctors to become consultants—which, of course, is a legitimate ambition of all of them—and will mean that consultants can play a fuller part in covering some of those duties which at present lead to junior hospital doctors being on call for unacceptable periods.

Will the Minister's proposals have any impact whatever on the vast number of people waiting for consultant or other services in physiotherapy? Will they help the children in special schools—such as the Emily Forty school, the Greenacres school, the Long Close school and the Western Park school in my constituency —who cannot walk, and many of whom can scarcely move? There are not enough consultants, doctors or physiotherapists to look after them.

I have already pointed out to the hon. and learned Gentleman, but I think it is worth repeating, that the number of consultants in the country is scheduled to go up by 5,000, or over 30 per cent., over the period. There has never been so much expansion, and, of course, it will take place across the board. [HON. MEMBERS: "Answer the question."] I have answered the hon. and learned Gentleman's question.

To as the Secretary of State for Health when he next intends to meet the British Medical Association; and what he intends to discuss.

I have no plans to meet the BMA, but I have arranged to meet representatives of the medical profession through the joint consultants' committee tomorrow to discuss the implementation of the NHS White Paper "Working for Patients".

While thanking my right hon. and learned Friend for that reply, may I ask him please to obtain from the BMA an apology for the distortions with which it is frightening patients? Does he agree with me that if the purpose of its campaign is to persuade Ministers and Conservative Members of Parliament by the mindless barrage of propaganda that it is putting out, it is singularly unsuccessful? The main beneficiary of this propaganda appears to be the advertising agency handling the account. Will my right hon. and learned Friend accept from me that, he and I having been in the House together for more than 19 years, I am more than happy to recommend his advice rather than that of the BMA to my constituents?

I have written to all GPs under contract in England, setting out why we disagree strongly with the five principal assertions made in that leaflet, and why we say that they are all untrue. I have invited GPs to consider whether they want to carry on putting the leaflet in their surgeries, and I am glad to say that I think that many of them do not. I look forward to having sensible negotiations with the BMA, if it will return to constructive proposals, about how to improve general practice in this country. Some of the campaigning on which it is spending such money is not really helping to improve the atmosphere, or the prospects for patient services either.

When the Secretary of State meets the consultants, as he has said he will, will he ask them if the people appointed to the new consultant posts that he intends to agree to—the 100 posts that have just been mentioned—will accept that they must devote 100 per cent. of their time to the National Health Service, and not, as at present, be permitted to devote as much time as they like to private medicine, using National Health Service facilities, and charging old people, who cannot wait in the queue any longer, exorbitant prices for operations that should be performed free?

Consultants are able to enter into contracts on the present basis with the National Health Service. They can be full-time, and maximum part-time, and so on. What we have ensured in the White Paper is that district health authorities will agree a job description with each consultant each year and will act as the agents of the regional health authorities in ensuring that that job description is, indeed, fulfilled by the consultant. So the consultant will be paid according to the extent of his commitment to the National Health Service, and the district health authorities will be able to ensure that that commitment is carried out.

Does my right hon. and learned Friend agree that much of the confusion in the minds of the public in relation to the proposed reforms of the Health Service stems from a mixing of aspects of the general practitioner contract with proposals set out in the White Paper, and that this misinformation is largely perpetrated by some GPs who do not understand the differences themselves? Will my right hon. and learned Friend take the opportunity for further negotiations to get the GP contract settled, so that discussions about the White Paper reforms may continue, and the beneficial ideas in the White Paper may be discussed and put into practice?

I agree entirely with my hon. Friend's analysis. My experience in discussions has been the same as his. I sent to all general practitioners a copy of the White Paper on the National Health Service review and the relevant working papers that related to the White Paper. I sent out separately the proposals for a new contract, in which I described the stage that we had reached in our discussions and negotiations. I asked all general practitioners to read whichever parts that interest them but to keep them apart and made it quite clear that discussions on the contract—where we hope to reach a reasonable conclusion, if people will accept the aims of the new contract—are one thing and that the evolution of the Health Service review is quite another. A great deal of discussion still has to take place on that while we are getting the details in place. The sooner that we can settle the contract and stop this protracted negotiations battle, the sooner we shall get on with implementing the NHS review.

When the Minister next discusses the general practitioners' contract with the British Medical Association and the general medical services committee will he deal with the concessions that have been made in the tartan contract—the concessions on basic practice allowance, the retention of the rural practice allowance and the lowering of screening targets? Will those concessions be offered throughout the United Kingdom so that they become the basis for a United Kingdom contract?

I discussed the details of the tartan contract, as the hon. Gentleman described it, with my right hon. and learned Friend the Secretary of State for Scotland before he issued it. That contract reflects in part our reactions to the submissions that we had received on the contract and expresses Scottish conditions. Average list sizes in Scotland are smaller so doctors have, on average, fewer patients. The average level of vaccination is lower and targets are adjusted accordingly. Moreover, doctors serve many scattered rural areas. I shall be interested in the reactions of the general medical services committee and of anybody else to the provisions in the Scottish contract. The Government sought to react to the representations made to us. We have tried to meet local conditions in order to ensure that good practice is encouraged.

To ask the Secretary of State for Health whether he has any plans to privatise the National Health Service.

No, Sir, and I never have had any such plans.

Will my right hon. and learned Friend sanction a modest amount of public expenditure to enable a special courier to take, by motorcycle, a copy of this exchange to BMA house, Tavistock square, because the BMA may not be aware of that fact? Is it not highly regrettable that those who are in a position to know the truth should seek so fundamentally to mislead their patients and our constituents?

I agree with that, but I do not think that the BMA believes that we have any intention of privatising the NHS, or that we ever had any such intention. I think that the courier should be diverted to Walworth road. As we have seen this afternoon, the Labour party has no particular contribution to make at this stage to the evolution of the review or the doctors' contract. It is continuing to fight a totally bogus battle against a proposition that only the Labour party believes was ever made.

Has the Secretary of State seen a copy of the report that I am holding in my hand from the General Audit Office in America—the American National Accounting Office—to the House of Representatives? It deals with private health care in America, roundly condemns the principle of fixed budgets and says that they lead to a reduction in health care. Will he send a copy of the report to every Member of the House before the next debate on these matters so that we can learn the truth from the experience of general practitioners in the United States of America?

I believe that the British health care system is superior to that in the USA. There are centres of excellence in the United States where extremely high standards of medical care are achieved. There are also centres of excellence where extremely high standards of management and use of resources exist. We could learn from that experience. However, my White Paper proposals have nothing whatever to do with taking the National Health Service in the American direction. We remain firmly committed to the principles upon which the National Health Service is based.

Given that there are wide differences in cost between different hospitals for the same operation, and that waiting lists vary so greatly, has my right hon. and learned Friend received from the BMA—or, indeed, from the Labour party—any suggestion as to how this matter might be dealt with? Is not the Labour party's only vision of the future of the NHS one that is safe for COHSE and NUPE?

My hon. Friend touches on one of the important problems in the National Health Service, and given that there are these apparently inexplicable differences in performance from place to place, it must be a worthwhile objective to so organise the Health Service that we raise standards everywhere to the high level achieved in some places now. I have most certainly received no proposals from the Labour party on that or on any other subject relating to the review. I look forward to receiving constructive proposals from the BMA which address the main point of how to raise standards everywhere for the benefit of patients.

Has the Secretary of State read his own White paper? Is he not aware that it is dripping with commitments to privatisation? Will he put the record straight and confirm that GPs with practice budgets will be expected to use NHS money to buy private treatment? Will he confirm that opt-out hospitals will be expected to use NHS facilities to bid for private patients? Will he further confirm that today's Finance Bill contains a cash subsidy to private medicine? Does it not speak volumes for this Government's lack of commitment to a public Health Service that the very first proposal from the White Paper to be brought before the House is a straight cash hand-out to private medicine?

The right hon. Gentleman has impaled himself on a hook by making such an allegation about privatisation, and he can find no factual basis in the White Paper or anywhere else to justify it. What he is describing are proposals which ensure that patients and GPs have the maximum choice to use National Health Service money to get the best quality service where they can find it, and provided as quickly as possible. That cannot be described as privatisation. It is using the taxpayers' money to the best advantage of the patient, and it is absurd to claim that we should exclude doctors and patients from high-quality operations provided quickly because we are using excess private sector capacity at a low cost. That is an enhancement of the service and no kind of privatisation at all.

My right hon. and learned Friend's answer will be regarded as what it is—clear and the truth. Would it not have been better if the BMA had kept to the truth instead of launching an outrageous campaign to frighten little old ladies and other poor pensioners?

I certainly would welcome it if the BMA withdrew its untruthful leaflet and substituted one which tried to make constructive proposals on the contract. I certainly hope that all doctors will forbear from making untruthful allegations to elderly and vulnerable patients, so causing them needless alarm. The contract seeks to enhance services to elderly people and I trust that doctors will acknowledge that and seek to build on it.

To ask the Secretary of State for Health what representations he has received regarding the numbers of mentally ill and mentally handicapped people who, after being discharged from hospital, subsequently became homeless.

We have received representations from voluntary bodies and individuals about the level of support available to patients discharged from hospital, some of these expressing concern that such patients risk becoming homeless.

Has the Minister read the report "Slipping through the Net" by the National Schizophrenia Fellowship? Is he aware that it is a terrible condemnation of the Government that schizophrenics and other mentally ill and mentally handicapped people are so deprived of community care that they end up on the streets, in prisons or in coffins? Does he accept that the only answer is first, to stop closing the hospitals and secondly, to provide adequate resources for these very desperate people?

I have read the report that the right hon. Gentleman cites and I can make it quite plain that no mental illness hospital should or will close unless there are adequate facilities in the community for the care of those who have been discharged from hospital, or have not been in hospital. Next week, we shall be issuing guidelines to district health authorities as to how they are to put in place by 1991 adequate community care facilities for the mentally ill.

In associating myself entirely with the remarks of the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) I must tell my hon. Friend that his remarks are totally untrue. Many mentally ill or mentally handicapped people are homeless or in prison because psychiatric hospitals and hospitals for the mentally handicapped have been closed prematurely without adequate accommodation and trained personnel in the community to look after them. Will he ensure that no further psychiatric hospitals close?

Perhaps my hon. Friend did not catch what I said in reply to the right hon. Member for Stoke-on-Trent, South (Mr. Ashley). I repeat that we endorse the policy which has been in place for 30 years of moving those who are mentally ill from the large, isolated Victorian asylums to proper facilities in the community. I agree with my hon. Friend that the challenge is to provide proper community care facilities.

To ask the Prime Minister if she will list her official engagements for Tuesday 25 April.

This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today.

Is the Prime Minister aware that the Select Committee on the Environment recently produced a report about the disposal of toxic waste and that the chairman said that only God knows what time bomb we are sitting on because of fears that toxic chemicals will get into our water supply? Is she further aware that the Select Committee unanimously condemned the Department of the Environment for its lack of leadership and control? In view of the Prime Minister's statement that the present Secretary of State for the Environment is the best there has ever been, how does she reconcile those two views? Who is telling the truth?

I speak from my recollection of reading that full report, but if the hon. Gentleman looks at the list of action taken, he will find that action by the Government goes back to 1983. Our action in regard to beaches goes back to 1979. The Labour party did nothing about the beaches directive for four years and we had to take immediate action. As I have pointed out, there will be another major Bill to implement the consultation that we have had this year.

Does the Prime Minister agree that our doctors are the custodians of the nation's health but that by the same token, they are also procurement officers on behalf of the taxpayer and the National Health Service, collectively placing orders worth millions of pounds every day? If we are to have a cost-effective and efficient Health Service, we have to make provision for an aging population. Is it not therefore a pity that we are subjected to the politics of fear, envy and myth which, in one word, is Socialism?

I am very glad to see my hon. Friend back, clearly absolutely recovered. In addition to what he has said, for every £1 that was spent on the Health Service in 1979, £3 is spent today, on more doctors, more nurses, more and better hospitals and very much better care of which he has probably been a recent beneficiary.

When two thirds of the people of West Germany are against the modernisation of short-range nuclear weapons, are not the German Government absolutely right to act on their view?

Short-range nuclear weapons are part of the NATO strategy. NATO strategy is being discussed and NATO strategy cannot be determined by any one country.

When we are told that the Warsaw pact has a 16:1 advantage in short-range nuclear weapons, does it not make sense for Britain and for NATO to gain the most by negotiating their verifiable removal?

I thoroughly agreed on that point with an early-day motion which appeared on the Order Paper on 9 February 1989 congratulating

"the Socialist Prime Minister of France on his … statement … that 'conventional and nuclear weapons are jointly necessary for the security of Europe',…that 'despite some initial signs of an unquestionable desire for disarmament in the Soviet camp, we are still far from seeing the reasonable sufficiency or the defensive posture that they claim', and that we must avoid having disarmament 'become a smokescreen for denuclearisation.'"

I am glad to hear the Prime Minister quoting a Socialist President. I quote to her a Conservative Chancellor. Does she agree that there should be

"'early negotiations on short-range nuclear weapons based on the goal announced by the Alliance in Reykjavik in 1987 and in Brussels in 1988 to achieve equal numbers at lower levels' and … 'negotiations on nuclear artillery with the aim of achieving equal ceilings at levels that are drastically reduced'"

I do not think that the right hon. Gentleman could have heard my first answer to him—[Interruption.] The strategy that we are discussing is the strategy of NATO, which has protected peace for 40 years. It is the strategy which the right hon. Gentleman does not accept and which he wishes to throw away. The strategy on which he is engaged is to get the denuclearisation of Europe and to have no safety left in defence in NATO for this country.

Is my right hon. Friend aware that there are many parliamentarians both here and on the continent of Europe who share her deep concern about the West German Government proposal to start talks on short-range nuclear weapons with the Warsaw pact countries unilaterally in advance of reductions in chemical weapons and conventional forces?

I agree with my hon. Friend. NATO has played a vital role in maintaining Germany's freedom, which started the day the second world war ended, and I do not believe that the German Government want to put NATO at risk.

To ask the Prime Minister if she will list her official engagements for Tuesday 25 April.

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

In view of the fact that in February of this year the south Yorkshire police instructed Barnsley football club to admit 2,000 spectators to an FA cup match at one minute before the kick-off without payment and without tickets, will the Prime Minister now consider delaying the Football Spectators Bill until after Lord Justice Taylor reports or, even better, withdraw it altogether as such police action clearly makes that Bill unworkable?

I answered some questions from this Dispatch Box last week pointing out that there had been nearly 300 deaths in the post-war period from crush and hooliganism in football, that unless we had a Bill we should be unable to take any action contained in the measure apart from the national membership scheme and that I believed that, against that number of deaths, for the House to wash its hands of such a Bill would be negligent in the extreme.

Does my right hon. Friend agree that anyone of reputable character—a public company, a national newspaper or a child playing in the street—on finding documents or property lost, stolen or fallen off the back of a lorry, would, as their first action, seek to return it to its rightful owner?

Not in my constituency.

Should not all thieves be treated equally before the law?

What my hon. Friend says is correct and most people would agree.

What is the limit, if any, below which the Prime Minister would not be prepared to let child benefit be cut?

Our policy on child benefit has been set out. We increased child benefit to the poorest families, which gave them far more help than they would have had if there had been an across-the-board increase. I am happy to say that that policy was endorsed by a majority of 100 yesterday evening.

Bearing in mind that we are this month marking the 40th anniversary of NATO, will my right hon. Friend take the opportunity to discuss with her colleagues at the Department of the Environment the recent decision by Norwich city council to throw out an exhibition which was installed to mark the 40th anniversary of NATO? Does she agree that that Labour-controlled council has pointed up the Opposition's confusion on defence matters?

My hon. Friend makes his point effectively. NATO has kept the peace in Europe for over 40 years. We are firmly behind NATO's strategy—which is a mix of conventional and nuclear weapons—as, I believe, are the United States and the overwhelming majority of NATO members. Anything that undermines NATO would be highly damaging to the defence of liberty.

To ask the Prime Minister if she will list her official engagements for Tuesday 25 April.

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

Does my right hon. Friend agree that one of the principal achievements her three Administrations has been the way in which the trade unions have been firmly brought under the rule of law? Would she care to say what the effect would be on the economy and on employment of a return to the secondary picketing advocated by Opposition Members?

The effect would be utterly devastating. We would go back to secondary strikes, in which there was no dispute between the employer and the employee and we would see again some of the massive strikes that we had in Labour's last period of office, during which about 13 million days a year were lost through strikes— a situation that would not have been encountered under a Tory Government.

To ask the Prime Minister if she will list her official engagements for Tuesday 25 April.

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

Does my right hon. Friend agree that some doctors have behaved in a most irresponsible and non-professional nammer in their treatment of elderly and vulnerable patients—[Interruption.]

Order.

The doctors have frightened their elderly and vulnerable patients about the effect of the National Health Service review. Will my right hon. Friend emphasise to the British Medical Association—the doctors' trade union—before its conference on Thursday, that it should stop using patients as a political battering ram and should instead sit down to discuss the proposals with the Department of Health?

Yes, I wholly agree with my hon. Friend. My right hon. and learned Friend the Secretary of State for Health answered the doctors effectively in some of the letters which he sent in reply to them. There are more doctors with more resources than ever before in the Health Service and the objective of the National Health Service White Paper is to give better health care, to give greater choice and to produce greater satisfaction and rewards for those who work in the NHS and who successfully respond to local needs. The changes proposed in remuneration before the White Paper are planned to distribute the same amount of money to doctors, but by way of distributing more to those who have a bigger case load than to those who have a smaller case load. That seems eminently just.

To ask the Prime Minister if she will list her official engagements for Tuesday 25 April.

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

Is the Prime Minister aware that there is an important Roman site in Upper Thames street near St. Paul's cathedral, which is the site of the palace of Julius Agricola, a former governor of London?

Order. The question must have to do with the Prime Minister's responsibilities.

The site is threatened by office development and there are difficulties with English Heritage and the developers about compensation that might be paid if the development is kept in abeyance while archaeological inspection continues. Will the Prime Minister please look at the matter urgently because the site is of great significance not only to London but to the nation?

I am aware of the site and of its importance. I am sure that the hon. Gentleman will be in touch with the Department of the Environment, under which English Heritage comes. If it comes to a final decision on planning, that would be for my right hon. Friend the Secretary of State for the Environment to determine.

Is the Prime Minister aware that the first compensation payments will shortly be paid from the Hillsborough disaster fund? Is she also aware that the poorest families may—[Interruption.]

Order.

Is the Prime Minister aware that the first payments will shortly be paid from the Hillsborough disaster fund? Is she also aware that the poorest families may, as a result of gaining help from that fund, lose their entitlement to social security payments? As I cannot believe that the nation contributed generously to that fund so that the Treasury would be the net beneficiary, and because I do not believe that the Treasury would wish to be the net beneficiary, will the right hon. Lady undertake to review the disregard rules so that the poorest families can gain help from that fund and keep their social security payments?

First, I am not sure what the status of the Hillsborough disaster fund will be. As the hon. Gentleman will be aware, other funds have chosen to have charitable status, but I am not sure what decision has been made about the Hillsborough fund and that will affect the way in which the payments are made. Secondly, as the hon. Gentleman knows, other disaster funds have had charitable status and they must have worked out a reasonable way forward on this matter. I do not think that we can change the rules and regulations, but I shall look to see how similar funds have worked.