To ask the Secretary of State for Health what was the average capital expenditure within Trafford area health authority at constant prices (a) in the period 1974–79 and (b) 1979–1991.

Using 1990–91 prices, average capital spending between 1974–75 and 1978–79 was £2,526,000 a year. Between 1979–80 and 1990–91 spending was £3,083,000—a real increase of 22 per cent.

I thank my hon. Friend for that reply. Is not it clear from those figures and from many others that it takes a Conservative Government to deliver the goods to NHS patients and that all the Opposition have to offer are promises which more often than not prove false? Will my hon. Friend congratulate Trafford area health authority and everyone involved in the hospitals there on the excellent job that they are doing and especially on the way in which they have brought down waiting lists?

I certainly endorse my hon. Friend's remarks. All that the Labour party offers is promises and rhetoric; we have delivered an improved health service. My hon. Friend will know in his part of the world of the £2 million new maternity unit, the £2 million mental illness unit and the £4 million geriatric and physio unit—all practical achievements. As my hon. Friend rightly pointed out, no patient in his area waits for more than two years and there has been a dramatic fall in the number of those who have to wait a year. That, too, is a practical achievement in the health service. It is high time that the Opposition gave recognition to all in the service who have achieved these excellent results.

When I hear Tory Members speaking about the health service, in Trafford or anywhere else, I am bound to come to the conclusion that they are after family jobs. Why does not the Minister condemn the appointments of spouses of Tory Members and of Members of the House of Lords who pick up more than £5,000 a year for doing a day's work? It is time this scandal was put to an end.

That is a slightly strange remark to make to me. The hon. Gentleman, who is always well informed, may be aware that I have an uncle who was a Labour Member of Parliament and in the Cabinet. His wife was the chairman of a health authority and she performed that job excellently for many years. I urge the hon. Gentleman to go to Friern hospital. The reason why I feel so strongly about the care of the mentally ill is because of all that my aunt, Peggy Jay, taught me. No one ever cast smears at her on account of her excellent achievements. Those whom we have appointed were chosen on their merits and because of their strong and unequivocal commitment to our national health service.

Is my hon. Friend aware that she has just scored a marvellous bull's eye? Does she agree that the Trafford figures show a dramatic fall in waiting lists and that that is a tribute to the efficient way in which the health authority has managed its operating theatres? Does not it also prove, as my hon. Friend the Member for Davyhulme (Mr. Churchill) said, that the Conservative Government are spending more on the health service and does not it nail the falsehoods repeatedly advanced by the Opposition? We have to go back a little way to remember that in 1976 they presided over the most savage cuts ever imposed on the national health service.

The only time spending on the national health service has been cut was when the Labour party was in power. My hon. Friend is right that management as well as money is what counts. The achievements of his health authority are remarkable. It has one of the lowest rates of cancelled operations in the country. It is organising the service, delivering high-quality care and using manpower and finance to the best possible effect.

To ask the Secretary of State for Health if he will reconsider making a Government contribution to the costs of the Cornwall air ambulance in view of its contribution to meeting the target for emergency ambulance call-out times.

No, Sir. It is for the local management of the service to determine the most effective deployment of resources to meet performance targets.

The Minister will know that those targets can be met only by the air ambulance in my area. Without that ambulance the target set out in the patients charter would not be achievable. Will the patients charter be guaranteed by public funds or is it to depend in future on private charity?

The patients charter sets out standards which ambulance services are expected to match. It is for the chief ambulance officer of each area ambulance service to decide how best to match those standards. The hon. Gentleman should note that although the Cornish air ambulance makes a valaable contribution in the county, it has not produced a measured improvement in response times for ambulances in Cornwall.

May I ask my hon. Friend nevertheless to keep in touch with the health authority in Cornwall? The county is 100 miles long and my constituency is the most sparsely populated area of Cornwall. Many of my constituents live 50 miles from the nearest district general hospital. I urge my hon. Friend to keep in close touch to make sure that response times are up to the charter.

We shall certainly keep in close touch with the Cornish ambulance service and, of course, with every other ambulance service to ensure that they match response times and put to good use our investment in the ambulance service. That investment has provided defibrillators for more than 2,300 front-line ambulances across the country and carries through the commitment to provide a trained paramedic on each front-line ambulance by 1996. Those improvements in the ambulance service will apply in Cornwall as they apply in the rest of the country.

To ask the Secretary of State for Health what is the projected capital spending in the NHS in the next three years; and if he will make a statement.

For the future, my hon. Friend will have to await the autumn statement by my right hon. Friend the Chancellor of the Exchequer which I understand will be made tomorrow.

Since 1979 we have increased capital spending on average by 4·3 per cent. per year. Labour when in office cut it by an average of 6·7 per cent. per year.

Is my right hon. Friend aware that that means that since 1979 there has been a two thirds increase in capital spending compared with a cut of one third when Labour was in power? Is he aware that the North Western regional health authority has a record capital spending programme for next year of more than £100 million and that it includes Bolton's new hospital?

Those dramatic figures are correct. Labour's record on capital spending was lamentable. It was about a one third cut in real terms in capital spending in Labour's last period in office. The North Western regional health authority has a magnificent capital programme for new projects beginning next year and at the head of that programme is Bolton general hospital. That will cost about £37 million in bricks and mortar and another £10 million for equipment. There are also major new projects at Chorley and South Ribble, Iancaster, Central Manchester, Salford, Tameside and Glossop. As I say, the total is about £100 million for next year.

As the Secretary of State is aware, Westminster hospital is due to close and the accident and emergency department is to move to St. Thomas's hospital. Will the right hon. Gentleman give a commitment that capital will be made available in time for the accident and emergency unit to be completed and ready to receive patients when Westminster hospital closes?

As the hon. Lady knows, the commitment to the new Westminster hospital on the old St. Stephen's site is one of the biggest of all the projects in the national health service. The change will need careful management to ensure that the major gains for patients that will come from it are properly realised. I shall look into the specific matter that the hon. Lady raised.

Does my right hon. Friend agree that those figures sit ill with the, I am sure honourable, argument of the Opposition that we are trying to close the health service? How can we be spending two thirds more on capital equipment? My right hon. Friend must be wrong when he says that we are spending 4·3 per cent. more in real terms on the health service than when we came to office. The Opposition tell half-truths because Labour is the only party which when in office cut national health expenditure.

The previous Labour Government started off with their normal irresponsible pledges which produced enormous inflation and catastrophic cuts to all public service capital programmes. Nowhere did those cuts hit harder than in the health service. Many of those who are now on the Opposition Front Bench were deeply ashamed of that at the time and remain deeply ashamed of it. They are right to be so ashamed.

To ask the Secretary of State for Health if he will make a statement on the operation of hospital trusts.

There is increasing independent evidence that the first trusts are proving that bringing management back into the hospitals is already bringing benefits to patients and staff. Waiting times are coming down in most places and staff report improved management and job satisfaction.

When the Secretary of State made his recent announcement in the House of the second wave of trust applications and approved in principle applications for the four London teaching hospitals he said that, in the interim, until the review was completed, they would benefit from the advantages that could flow from greater local hospital management devolution. If that is a benefit short of trust status, why is it necessary to force through trust status while encouraging local hospital management and in so doing to bring the assets, the buildings and the personnel out of local health service management? Why is that superior simply to having better efficiency through greater local management?

It is not difficult to explain. Some of the benefits of devolved management can be achieved without full trust status, but, for local management, one of the major gains of full trust status is full control of capital. That is one reason why hospitals seek it. I hope that the hon. Gentleman is clear on that matter.

Does my right hon. Friend agree that it is significant that the two major hospitals in Kidderminster district health authority have increased the number of in-patients treated over the past eight years by 14 per cent? The health authority, one of the 30 most efficient in the country, is consulting on third-wave trust status because it believes that it can give a better service to patients and local people on that basis. Does not that contrast with the recent comment by the general secretary of the Institute of Health Service Managers on the Labour party's plans for the health service? She said that they were an unworkable mess.

I agree with my hon. Friend. Labour's role in all this is somewhat disreputable. I draw the attention of my hon. Friend to the recent threats issued by the Labour party candidate in Orkney and Shetland, who said that, by doing this,

"it could certainly be argued by an incoming Labour Administration that you had contributed to your own redundancy."

As my hon. Friend pointed out, Labour played a disreputable role in relation to trusts. When I drew the attention of the Leader of the Opposition to a previous threat of this kind, made by the hon. Member for Coventry, South-East (Mr. Nellist), the right hon. Gentleman withdrew it at once. I hope that the Opposition chief spokesman on health matters will withdraw this similar threat today.

Will the Secretary of State think for a moment about the effects of NHS trusts on the low-paid hospital staff, who are just as essential as medical staff in the running of the hospital? I am thinking of domestics, porters and maintenance staff, who are grossly underpaid and who are suffering badly as a result of administration of hospital trusts and the attempts to break away from the national negotiating machinery.

I would strongly argue that the national negotiating machinery has, over the years, delivered low pay to such people. The increased flexibility of NHS trusts will allow them to pay more where the local markets can afford it and I predict that this will increase the pay of the lower-paid staff in such hospitals. That is why, to the embarrassment of the Labour party, some of the local branches of those unions are beginning to support trusts.

When it comes to Opposition claims about NHS trusts, should not we bear in mind that, two years ago, the hon. Member for Livingston (Mr. Cook) was telling everyone that general practitioner contracts would result in less time being spent with patients? That turned out to be untrue, so why should we now believe these spurious scares about NHS trusts leading to privatisation? Is not the truth of the matter that the hon. Gentleman is interested only in using his spurious scares to frighten the sick and the vulnerable for his own party ends?

The scares that the Labour party tried to run on these matters have rebounded on it. I remind the hon. Member for Livingston (Mr. Cook)—he seems not to wish to rise on these matters—that the letter from the Labour party candidate to the trust applicant reads:

"Were you to do this"—

continue with the trust—

"in the face of so much opposition, it could certainly be argued by an incoming Labour Administration that you had contributed to your own redundancy."

When I drew the attention of the Leader of the Opposition to previous threats of that sort, he wrote as follows:

"Of course I can confirm that there will be absolutely no action of this kind."

The hon. Member for Livingston must respond to these scares. Indeed, they are worse than scares, they are threats.

Will the Secretary of State confirm—[HON. MEMBERS: "Answer!"] If Conservative Members paid attention to the issue they would know that my hon. Friend the Member for Livingston (Mr. Cook) repudiated the threat last week.

Will the right hon. Gentleman confirm that the majority of first-wave trusts face serious financial problems? How much will he spend to bail out the first-wave trusts so that they do not end the first financial year in deficit?

I am sorry that the Labour party's chief spokesman on health did not rise to respond to these matters. He should stand up and repudiate the threat in the House.

The hon. Member for Peckham (Ms. Harman) is completely wrong on the facts. If she wishes to attach herself to the scare, I am delighted. As I have said, she will find that she is completely wrong.

To ask the Secretary of State for Health how many additional patients are now being seen by the Rugby NHS Trust as against last year; and what percentage increase that represents.

In the period April to September 1991 6,715 in-patients were seen at Rugby NHS Trust—an increase of 3·7 per cent. over the same period last year.

I am grateful to my hon. Friend for that helpful and cheering response. Clearly it is good news for the people of Rugby and especially for patients attending St. Cross hospital. It represents a fine effort by the management and workers of the hospital. Does my hon. Friend agree that the way forward is signposted to other improvements in the health service? Will he therefore redouble his efforts to promote NHS trusts while ignoring the ill-founded criticism of Opposition Members, who are prepared to argue more for party dogma than for patient care?

My hon. Friend is absolutely right. He chose a good day to raise the matter, because only yesterday the hospital opened a new out-patients department. The hospital's track record on waiting lists bears comparison with any in the country, with the number of those waiting for more than two years for in-patient treatment having decreased since June 1990 from 137 to 18. Since the trust has been established we have seen the appointment of new paediatricians, the introduction of new laser technology, a commitment to new surgeons in the general surgery and accident and emergency departments and the continued development of improved accident and emergency facilities in the hospital.

To ask the Secretary of State for Health if he will make a statement on the patients charter.

The patients charter demonstrates our commitment to providing high-quality services within the NHS which are responsive to people's views and needs. It has been widely welcomed, for example, by the Consumers Association, which said that

"it is a golden opportunity to put patients first."

Will my right hon. Friend confirm that this is the first time that any Government have introduced a genuine patients charter of rights? Secondly, does he agree that the quickest way to ensure longer waiting lists, unreasonable behaviour and hospitals again being run by unions rather than by consultants is for power to be given to the Labour party?

That is correct. The structure of open agreements between district health authorities and hospitals gives us, for the first time, a clear way of setting standards, monitoring them and enforcing them. That is a great gain from the reforms. The first step to patient responsiveness is encapsulated in the patients charter.

Did not the patients charter cost £2 million to publicise and launch and was it not £2 million worth of Conservative propaganda? Have not we heard planted questions this afternoon that have contained carefully worked-out statistic after statistic? It has been a public relations exercise for this week's by-elections. We are in the run-up to a general election and every figure that the Secretary of State has produced today has been carefully worked out and planted among Conservative Back-Bench Members as a publicity stunt, just like the patients charter.

The hon. Gentleman fails to understand the importance of the patients charter, as he fails to understand the reforms. It is vital that we get across the fact that under the reforms in the NHS we can now set proper standards of care throughout the country. It is vital that, in the agreements reached next year, we set out what is to be done nationally and locally. That is inherent in the reforms. It is right that every household should know its rights under the NHS.

The whole operation on the patients charter—the printing and so on—has cost about £2 million. That expenditure is well worth while if it gets across to people the facts about what their rights really are.

As the right hon. Member for Islwyn (Mr. Kinnock) and his Front-Bench team are so singularly ill-informed, why does not my right hon. Friend invite them to the Department for a teach-in, when they could be given the true facts and figures? Let them then spread all these lies.

We have been trying to brief some Labour Members, especially the London Members. Some of them have been invited again and again to meet the London ambulance service for a briefing other than that which they get from the trade union. They refused to come.

Following the disclosure during the past 24 hours of the outbreak of legionnaire's disease at two Liverpool hospitals, does the right hon. Gentleman accept that an essential part of a patients charter should be the right to know when such outbreaks have occurred? Can he explain why that information was concealed for some weeks in one case? Does he accept that another element of the patients charter in this day and age should be that hospitals are constructed in a way that shows that we have learnt the lessons of the past? Equipment should not be installed if it is likely to give rise to legionnaire's disease.

I agree that one benefit of the patients charter and, indeed, of the reforms will be the greater availability of information. I am sure that the hon. Gentleman will want to be very careful not to scare people unecessarily. In the first incident, it still has not been shown that the infection derived from inside the hospital. All the necessary investigative and follow-up actions were taken and as soon as the problem was known local general practitioners were informed. I have considered the matter and I shall continue to do so, but I do not believe that there has been any dereliction of duty in this important matter. I am sure that the hon. Gentleman, who is a responsible Member of Parliament, would not want to mislead people in this matter.

Is my right hon. Friend aware that the West Midlands regional health authority has just issued a special paper welcoming the patients charter and agreeing to do everything possible to turn rights into realities? Will he add one more right to the patients charter—that of peace and quiet for sick people in hospital? Is he aware that there is a growing practice of allowing unlimited numbers of people, for unlimited hours, to visit patients in wards? That is not conducive to recovery and nor is the practice of children running up and down wards for hours on end. I hope that my right hon. Friend will add that right to his patients charter.

I welcome the steps taken by the West Midlands regional health authority. The issues to which my hon. Friend referred are just those where the health service needs to do a little better on listening to patients' needs. We often receive letters about relatively minor matters that can easily be put right after discussion with patients. I am sure that the hospital that my hon. Friend has in mind will wish to take account of her comments.

Can the Secretary of State explain why the words "patient choice" do not appear in his patients charter? Is it because he knows that his new contract system has reduced patient choice? What does his patients charter offer to the thousands of patients who, through the College of Health helpline, have chosen a hospital with a shorter waiting list, but cannot get into that hospital because their health authorities will not pay for them to be treated there?

What does the patients charter offer to the woman in Wandsworth who last month found that she could not have her second child in the hospital that she chose for her first child because her health authority has no contract with that hospital? Why should the House take seriously any patients charter that does not give back to those patients the right to choose their hospital—a right that they had until the Government took it away?

The hon. Gentleman is wrong. Under the old system—the system to which the modern Labour party characteristically wishes to return—there was the freedom of the right to refer to any hospital and that right remains. However, that sort of reference was nugatory because the money did not follow the patient. We are moving towards a system where a choice will be made and that choice will become reality because the money will follow the patient and so enable that patient to be treated. That is what the hon. Gentleman still has not grasped.

On the matter of choice, the patients charter draws attention to new freedoms and the ease with which people can change their general practitioners, which is a fundamental improvement in freedom. I am sorry that the hon. Gentleman still does not understand that the whole drive behind the reforms is to back the general practitioner's decision with money so that choice becomes reality.

To ask the Secretary of State for Health if he will make a statement on the amount of NHS money applied to menopause research.

I regret that it is not possible separately to identify the money devoted to the range of conditions associated with the menopause from the £225 million spent on medical research last year. However, my hon. Friend will be aware of the current work which includes a review of screening techniques for postmenopausal osteoporosis and an economic evaluation of the benefits of hormone replacement therapy.

I thank my hon. Friend for her reply. I understand that the Government are spending somewhat less than £500,000 in that area. Is my hon. Friend aware of the proceedings of the international menopause conference which point out that the number of deaths of women in the post-50 age group from heart attack and particularly stroke is twice as great as the number dying from osteoporosis and 10 times as great as the number of deaths from breast cancer? Does not that mean that we should be putting a great deal more money into such research or is it to remain the Cinderella of medicine for ever?

My hon. Friend identifies why it is difficult separately to identify the sums of money. As she says, associated conditions are heart attacks, strokes and cancer. About £1·5 billion is spent on health research each year. Our new research strategy ensures that we get the best possible value from that and, above all, apply the lessons. However, I can give my hon. Friend the undertaking that as long as she remains in the House such research will not be the Cinderella of the health service. There are a great number of excellent projects. Should my hon. Friend happen to be in the Cleveland area, I strongly urge her to go to the South Cleveland hospital to see the excellent work being undertaken there with a bone densitometer.

Is not the Minister aware that it has been known for some time that four times as many women as men suffer the chronic pain that comes from the loss of movement in and the fracture of hip joints?

Order. I am not an expert, but does that question have something to do with the menopause?

You, Mr. Speaker, betray the ignorance of men if you do not understand the relevance of my question. The research has been done for some time and the results have been known for some time, yet still the Government do nothing.

I am pleased that there has been a threefold increase in, for example, HRT prescriptions during the past 10 years. We fund to the tune of £1·9 million about 40 voluntary organisations which help spread the message about the importance of HRT and the prevention of osteoporosis. Our recent leaflet on women's health, which has been a remarkable success, also provides information. However, the hon. Gentleman is right. When the research has been evaluated and the screening survey has been completed we will be able to make even further progress in ensuring that the health service is dedicated to prevention as well as cure.

To ask the Secretary of State for Health what are the latest figures for the full cost, and staffing details, of the income generation unit; and what are its aims.

The income generation unit is no longer a separate entity within the Department.

Has the income generation unit given advice to trust hospitals and health authorities on the building of private wings? Was such advice given to the Chesterfield and North Derbyshire Royal hospital? What is the difference between building private wings and privatisation?

During its existence the income generation union gave a wide range of advice to NHS units. For the expenditure of little more than £250,000 per year we have been able to generate extra funds to support and improve patient care within the NHS rising from £9 million in 1988–89 to £50 million last year. Part of those resources were raised from the sale of NHS facilities for the treatment of private patients. I cannot understand why some Opposition Members—we do not know whether this is the official Opposition Front-Bench policy—appear to believe that profits from private medicine must be preserved for private companies and not made available to the NHS to improve care for NHS patients.

Is my hon. Friend aware that with the help and advice of the income generation unit, a business man in my constituency has successfully installed private telephones in hospitals in the north-east, paid for by advertising? The only loser from that practice is British Telecom. Some of the profits made from BT telephones in hospitals, which Labour Members appear to think are excessive, can be recouped by the hospital and used to benefit patients.

My hon. Friend is absolutely right. Not only does that initiative produce a wider range of services to benefit patients and extra resources for the health service but an improved range of hospital facilities, so that services previously available only to private patients in private hospitals are increasingly available to all patients in NHS hospitals.

Was the income generation unit responsible for the policy adopted by New Cross hospital in Wolverhampton and the Mayday hospital in Croydon, whereby bedridden patients must hire a television for a minimum of three days at a cost of £1·95 a day—which is about twice the rate charged by high street television rental companies? Is it not scandalous that ministerial offices and the House have televisions provided by the taxpayer, yet bedridden patients who want to watch television to help them to relax must pay?

Hospital managers are responsible for providing such services, not any unit of the Department of Health. If the result of the income generation approach is that more resources are released to treat more patients and provide additional resources for their medical care, it does not seem that anyone should have to apologise for that policy.

To ask the Secretary of State for Health if he will make a statement on the aims of the Children Act 1989 with regard to improving the welfare of children.

The Children Act 1989 incorporates most private and public law relating to children. It sets out clearly principles for their care and upbringing, and is in effect a charter for children.

Will my hon. Friend firmly rebut the criticisms made by those who continue to argue that although the aims of that Act are excellent, the funding arrangements to support it are not?

The Act was implemented with an unprecedented level of co-operation and collaboration between central and local government and I pay a warm tribute to all those who helped with the delivery of guidance and the legislation's careful framing. The Lord Chancellor's Department and social services departments were involved in the training of 140,000 social service staff last year, when the social service standard spending assessment increased more than at any time over the past 15 years.

Is the Minister aware that the Act cannot be fully effective unless the provision of child psychiatric services is improved? Does she acknowledge the concern that exists about that aspect and can she explain what action the Government intend to take?

There will be an announcement in the relatively near future about the results of the review that we are conducting into arrangements for child psychiatric services. I announced such a review at a conference that I addressed the other day. The traditional pattern of child guidance services is not always adhered to and we must ensure proper integration in hospitals and the community. There has been a substantial increase in the number of child psychiatrists, a great increase in clinical psychologists and an increase in child psychiatric nurses. We must ensure that all staff with considerable expertise work to best effect in collaborating not only with the health services but with social and education services.

To ask the Secretary of State for Health what new hospital facilities are available to the residents of Wanstead and Woodford; and if he will make a statement about the funding of further phases of building at Whipps Cross hospital.

Phase 1 of the redevelopment of Whipps Cross hospital cost £18 million. It includes a new out-patient department, four operating theatres, a hydrotherapy pool, a new pharmacy, improved sterilisation facilities and three new wards.

The Forest Healthcare trust is committed to start phase 2 of the redevelopment of the hospital in the next financial year. This will include a dedicated day surgery unit, further expansion of out-patient facilities and two more new wards. In addition, the capital loans fund is financing the development of new facilities for physiotherapy, occupational therapy and other day services for people with a learning disability.

And finally, the Government's quality initiative is providing £384,000 to finance a new medical day unit at Whipps Cross hospital.

Having given us that excellent news, can my hon. Friend confirm that the commitment to spend £2·5 million on the start of phase 2 of the Whipps Cross hospital development will continue under the new trust arrangements? Can he give any indication about the further funding of phase 2 that will be needed, beyond that £2·5 million?

On the establishment of the Forest Healthcare trust, responsibility for allocating capital to the trust passes from the region to the Department. I can assure my hon. Friend that the Department will honour the commitment given by the region to provide £2·5 million to get phase 2 under way. For the remaining resources that will be needed, the trust will be competing in the national pool of capital resources that are available to NHS trusts.

To ask the Secretary of State for Health how many NHS consultants are on maximum part-time contracts; and if he has any plans to end this practice.

A total of 5,172 hospital consultants in England were on maximum part-time contracts on 30 September 1990. There are no plans to end the maximum part-time option, which has existed since the early days of the NHS.

On the day on which the Secretary of State gave a pledge to his party conference that everyone would have equal access to free health care, I was contacted by a constituent, Mr. Ronnie Watson, who had been waiting since September 1990 for an appointment with a consultant to discuss a possible hip operation and had just been told that he would have to wait until some unspecified date in 1992.

Mr. Watson had then telephoned the same consultant in the same hospital and had asked how long he would have to wait to be seen privately. The reply was that he could be seen the following Wednesday for a fee of £45. How can the Secretary of State reconcile that experience, which is being replicated all over the country, with the experience of Mr. Watson?

Even Barbara Castle did not outlaw the arrangement whereby consultants are able to conduct their private practices. The private practice must not in any way impinge on national health service commitments. The patients charter makes it clear that there will be local standards for out-patient appointments, as well as the national standards for general appointments.

We are seeing steady improvements. I very much hope that the hospital to which the hon. Gentleman referred will be able to consolidate further the remarkable progress that it has made over the past couple of years—a 56 per cent. fall in the number of two-year waiters and a 35 per cent. fall in the number of one-year waiters.

To ask the Secretary of State for Health what were the revenues for pay beds in the NHS in 1990–91.

Total private patient income for 1989–90 was £92 million. Information for 1990–91 is not yet available.

As the provision of day beds ought to be the responsibility of the trusts, will the Secretary of State take time today to condemn Labour's vicious attacks on those individuals who have been selected to help run the trusts?

I join my hon. Friend in deprecating the attacks made by the hon. Member for Livingston (Mr. Cook) on Anne Parkinson and Sheila Taylor, who have rightly been appointed to serve on trusts. I also join him in deprecating the attack on my noble Friend Lord Jenkin, who has accepted an appointment on a trust. I find it surprising that Opposition Front-Bench spokesmen wish to exclude spouses because of whom they happen to be married to when they have good records of public service.

The hon. Member for Livingston drew attention to the behaviour of previous Secretaries of State in this regard. Would he now like to condemn the behaviour of the last—and I mean last—Labour Secretary of State, Lord Ennals? At the same time as his hon. Friend the Member for Monklands, West (Mr. Clarke) is saying that pay beds are to be driven from the health service and given to private companies, Lord Ennals has taken a leading position as a director of a private healthcare company—while remaining a Front-Bench spokesman on health for the Labour party.

Is the Minister aware that an Essex GP is calling on national health service hospitals in the Mid-Essex health authority to boost incomes by carrying out privately, in pay beds, procedures that they have effectively banned from the NHS? Does the Minister agree that to increase income from patients excluded from free treatment is not only an abuse of the founding principles of the NHS but a classic illustration of the two-tier health service that his Government are introducing?

I welcome the hon. Lady to the Opposition Front-Bench team. I remember that when she came to the House she was, like her leader, a passionate supporter of CND. Their principles have gone by the board. As for the matter that she raises, I welcome the fact that GP fund holders, and all GPs, are doing more in their own surgeries, which cuts waiting lists and speeds patient care. I regret the fact that the hon. Member for Livingston saw fit not to answer the challenge that I laid down to him, just as he has not answered any of the challenges that I have laid down to him today, and that he has also seen fit to put the hon. Lady, on her first outing today, into a rather difficult position.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 November.

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 personally in favour of a single European currency—yes or no?

At this moment, in these circumstances, no.

Is my right hon. Friend aware that there is general support for the emphasis that the Foreign Secretary has placed on the importance of keeping the European Commission out of the nooks and crannies of our national life? Will he, in any negotiations with our European partners, give the highest priority to getting the European Commission under some sort of genuine parliamentary control?

I share the views expressed by my right hon. Friend yesterday. One of the things that we shall be seeking to do in the negotiations on the political union treaty is to try to ensure that the Commission—at present under no effective control—increasingly comes under the control of the most appropriate Parliament, in this case the European Parliament.

Since the Prime Minister acknowledges convergence to be a matter of considerable importance in the development of the European Community, why is it, now that the Engineering Employers Federation, the Confederation of British Industry and his noble Friends in the House of Lords have all made cause for new investment incentives for British industry, that he and the remainder of the Government refuse to take such initiatives in order to support this very best way of securing recovery?

On the right hon. Gentleman's first point, convergence is not just important; it is absolutely vital if there is to be any success whatsoever, or any prospect of a single currency that would not damage the whole of Europe. The most effective way of ensuring that there is investment in this or any other country is to ensure that we have low inflation and the right economic environment.

When unemployment has risen by 800,000 in Britain during the last year, when 50 per cent. more companies are in receivership and when manufacturing investment is down by 19 per cent., how can the Government justify taking such a listless attitude to the needs of British industry? Why do the Government refuse to give the same backing to British industry as our European Community competitors give to theirs?

It is not all that many months ago that the right hon. Gentleman was saying to the House and to people beyond it that the most important thing was to get inflation down from its then level of 10·9 per cent. and to recreate the conditions in which people would feel secure to invest. I agreed with the points that he made then and that is precisely what we have done. We are now reaching a position in which growth and investment will reoccur and, as we saw throughout the complete period of the 1980s, there will be a growth in the absolute number of jobs.

Since the Prime Minister said that it is important to create the conditions for economic and industrial success, will he listen to the CBI which, in its report asks the Government to take proper account of the interests of manufacturing industry instead of pursuing the policies that they are pursuing? After 12 years, is there any hope of the Government ever taking the interests of manufacturing industry properly into account?

If the right hon. Gentleman had paid more attention to the CBI yesterday, he would have heard the director general say that since the crash of October 1987, real take-home pay is up by 11 per cent., manufacturing productivity is up by 20 per cent. and manufacturing exports have increased by £76 million for each and every working day.

Does my right hon. Friend agree that the two essential components for a policy of nuclear deterrence are that one possesses the capability and that a potential enemy does not doubt one's willingness to use it in order to defend oneself? Does he agree that a few weasel words in a newspaper do not constitute a policy of nuclear deterrence, particularly when the leader of that party has stated clearly that he would never use nuclear weapons, even if Britain were under nuclear attack?

I share the view expressed by my hon. Friend. The fact that we have had a nuclear deterrent for a number of years has added materially to our security and I believe that we should continue to sustain that deterrent. It is a matter of regret that the Opposition's commitment to that deterrent is not generally accepted. The words of the right hon. Member for Chesterfield (Mr. Benn), "If we change to win, we could change when we have won", show that British people will not trust the Opposition with defence policy.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 November?

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

Why is the Prime Minister trying to turn the national health service into a family business for card-carrying Conservatives? Why did he appoint two Tory ex-Ministers, the sister of a Tory Minister, the wives of two Tory Members of Parliament and the husband of a Tory Member of Parliament to run opted-out hospitals? Is that what the Prime Minister means when he says that he believes that Conservatives want to use the national health service? They are using it—milking it for their own financial gain.

The hon. Gentleman has clearly forgotten that, for example, Lady Callaghan was an excellent chairman of Great Ormond Street hospital and a number of other wives of eminent people in public life have held that position. It is extremely odd that the Labour party should propose that women should be barred from jobs because of their husband's position in public life. Among those whom the hon. Gentleman has maligned is someone who has a decade's experience of working in the NHS. If the hon. Gentleman does not think that that is a proper contribution to the health service or a proper qualification for the job that she holds, I am very surprised indeed.

To ask the Prime Minister to list his official engagements for Tuesday 5 November.

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

Will my right hon. Friend anticipate the Chancellor's statement tomorrow to the extent of confirming that funds will be made available to ensure that our armed forces, although smaller, are even better equipped? In particular, will he confirm that conventional submarines will continue to play an important role and that the story broadcast by the BBC last night as a hard fact—that the HMS Upholder class of submarines is to be sold—is completely untrue and without foundation?

I can confirm my hon. Friend's last point. We have shown our commitment to better equipment by our recent purchase of the Westland helicopter and our decision to re-equip the Army with the Challenger II tank. Both were expensive but necessary purchases to ensure that our armed forces have the best possible equipment. That is our policy and will remain so. I am bound to say that that does not seem to be the policy of the Opposition. The principal Opposition party is committed to cutting defence expenditure by a quarter, and the right hon. Member for Yeovil (Mr. Ashdown) is committed to cutting it by a half.

The Prime Minister insists that even if the other 11 go ahead he is prepared to reject an agreement on Europe at Maastricht. Will he describe how he sees the future of this country, should he allow that to happen?

I have repeatedly made it clear in the House and beyond that I am working to seek an agreement at Maastricht that will be acceptable to the House and this country. That remains the position. I have set out our determination to work for that agreement and the principles on which the agreement will need to be based. I have arranged a two-day debate in the House so that I may express that clearly and listen to the views of the House. If I judge that the agreement is in the interests of this country I will sign it. If I judge that the agreement is not in the interests of this country, it would not be right for me to sign it and I will not sign it.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 November.

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

As this is the first Prime Minister's Question Time since the Commonwealth conference, may I congratulate my right hon. Friend on his constructive and positive approach to the issues? Will he confirm that he was not detained or locked up and was widely recognised as the leader of this party—unlike the experience of the right hon. Member for Islwyn (Mr. Kinnock) after four years as Leader of the Opposition?

I can confirm that it was an excellent Commonwealth conference. The Commonwealth came closer together than it has been for a long time. There was substantial agreement on changing policies on South Africa, which I much welcome, and there was a warm welcome for our decision to implement the Trinidad terms arrangement, which, if fully implemented by every member, will relieve the poorest countries in the world of $17,000 million of debt.

Is the Prime Minister aware that just over an hour ago I received a letter from British Mean, which has a factory in my constituency at Falkirk, informing me that 169 of the work force will lose their jobs, not because they are inefficient but because the machinery on which they work is 50 years old? If that is not proof of lack of investment, what is? Is the Prime Minister further aware that those men like their jobs and that, with his help, they would be able to keep them, but he is not prepared to help them? Try telling men in Falkirk that the economy is on an upturn.

The hon. Gentleman is clearly under the misapprehension that I have been Prime Minister for 50 years—not yet.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 November.

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

When my right hon. Friend next meets the British Medical Association, will he raise the success of the first wave of national health service trusts, particularly the success story of the South Devon Healthcare trust? In the past year, it has increased the number of patients by 10 per cent., the number of doctors and nurses by more than 50 and reopened two wards. Will he congratulate the BMA on its wholesale condemnation of the latest Labour party smear leaflet that has been distributed at the Langbaurgh by-election?

I am happy to join my hon. Friend in those remarks and to join the BMA in its scathing remarks about the Labour leaflet. The BMA said that the leaflet was in bad taste, and it must be very frightening to the people of Langbaurgh. Like my hon. Friend, I read the report of Labour's latest scare story about the NHS. I hope that people will realise that what Labour is saying is inaccurate. It is a tissue of falsehoods. I hope that people will look at the real record of improvement in the NHS, not the misrepresentations that they get from the Labour party.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 November.

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

Has the Prime Minister noticed that the major issue in the Kincardine and Deeside by-election is the widespread public opposition to the application by Foresterhill hospital in Aberdeen to become a self-governing trust? As the Minister with responsibility for health in Scotland clearly favours trust status and as the Conservative candidate has come out publicly against it, will the Prime Minister tell the House who he agrees with—his Health Minister or the candidate?

As the hon. Gentleman knows, the application for that hospital to have self-governing status has been submitted to my right hon. Friend the Secretary of State. He has an obligation to study that application and to determine whether it is in order. That is what he is doing. When he has done that, he will announce his decision.