To ask the Secretary of State for Health how the system of general practitioner fund-holding is progressing.

To ask the Secretary of State for Health if he will make a statement on the operation of the general practitioner fund-holding initiative.

It is clear that the first year of the scheme has brought a wide range of benefits to patients, and that has been confirmed by independent evaluation by Professor Glennerster at the London school of economics.

Has my right hon. Friend had a chance to reflect on the excellent report produced by Professor Glennerster and published by the King's Fund, which shows that fund-holding practices are more effective and efficient in delivering health care to patients, and that they use their resources much better? Could not he have arranged for that report to be leaked to the hon. Member for Livingston (Mr. Cook), because that might have prevented the hon. Gentleman from making the foolish pledge that Labour will abolish the excellent reforms?

I do not know whether the hon. Member for Livingston (Mr. Cook) likes to read things published in the normal way. If he had read the report, he would have found in it powerful evidence that his partisan ideological commitment to abolish the scheme is foolish. Professor Glennerster says that his research shows that none of the alleged scares about the scheme could be found to be true. He quotes Professor Maynard, who makes the basic point that decisions made closer to the consumer are more likely to reflect consumer information and preferences than an overall average view taken in a district planner's office. That is the strength of the GP fund-holding scheme.

Has my right hon. Friend noticed the success of GP fund holding in Nottinghamshire and the benefits that has brought to patients and the national health service alike? Does he agree that there is pressure to extend the excellent scheme and not—as suggested by the would-be Secretary of State for Health for Scotland—to abolish it?

I believe that there are four excellent fund holding practices in my hon. Friend's neighbourhood, and they have been adding to the region's total health care provision and are bringing new services to patients. I am under pressure from a wide range of general practitioners to bring the list size criterion down and to extend the range of care that can be purchased by GP fund holders. I am considering both points.

Is not the Secretary of State being slightly selective in the parts of the report that he uses? Is it not clear that it is an untried system, which is clearly producing a two-tier system for many patients, who are not receiving the very best care because their GP practices are treated as inferior to those that hold contracts?

The hon. Lady selects the wrong argument on which to call Professor Glennerster as witness, because he says that that argument is muddled. He shows clearly that he did not find evidence of the so-called two-tier phenomenon to which the hon. Lady refers, but that the total of care provided was increased. That benefits all patients because it takes the pressure off out-patient departments.

Is it not true that patients are refused access to services on financial grounds by GPs who are fund holders? May I draw to the attention of the Secretary of State the case of a Wakefield man who was refused expensive injections for infertility by a fund-holding GP and told to apply for that treatment to a non fund-holding practice in Wakefield?

May I also draw the right hon. Gentleman's attention to the personal circumstances of a friend whose wife is suffering from serious cancer? She was advised that she could not receive homoeopathic treatment because the fund-holding practice had no appropriate contract. Has not the experiment proved a disaster for vast numbers of national health service patients?

As always with selective, individual cases, there is more to them than meets the eye. I know a great deal about the difficulty of getting homoeopathic treatments referred by general practitioners because there is a homoeopathic hospital in my constituency. It is not a matter of fund holders versus non fund holders. There are a number of general practitioners who do not approve of such treatment.

Professor Glennerster considered carefully the argument that expensive treatments might be refused by fund holders and found no evidence of that yet. We fund the budgets on the basis of past practice so there is no reason for that to be so. I suspect that when we inquire into the matter, we shall find that the general practitioner had doubts about the treatment's clinical appropriateness.

Although my hon. Friend is right to say that budget-holding practices have been outstandingly successful and are now very popular with most doctors—

Sit down.

Order. I think that the whole House wants to hear.

Does my right hon. Friend, who is undoubtedly committed to improving health care, agree that the reforms make planning and the provision of supra-regional specialties very much more difficult? Will he ensure—and give me an assurance—that there will be careful monitoring?

I warmly endorse—of course—the first two parts of my hon. Friend's question, but I do not accept that his criticisms are well founded. Planning is based on good information and the internal market provides better information about GP, district and patient preferences. They can then be planned for.

Those working at a supra-regional and regional level believe that once the services that they can make available are known more widely, money will follow the patients to them.

I remind the Secretary of State that last month he claimed that the majority of GPs supported him on fund holding. Is he aware that the very next week, a poll of GPs showed that they believe, by a massive majority of 65 per cent. to 15 per cent., that his reforms are damaging the NHS? Is that what he calls majority support?

Is the Secretary of State aware that last week in North Tyneside, 53 operations were cancelled, whereas operations on four other patients from fund holders went ahead? Is he aware that in Bath, all cataract operations have been cancelled except for those involving the patients of fund holders and that in Norwich, the patients of fund holders are jumping the waiting list and entering private wards? I call that a two-tier service. Most GPs call it a two-tier service. It has no place in the NHS and the next Labour Government will end it.

I notice from a recent survey that Labour has achieved 13 per cent. support among GPs, so it has some way to go in winning the argument. When the hon. Gentleman finally gave me a straight commitment across the Dispatch Box to abolish GP fund holding, I told him that he delivered the support of the majority of GPs by doing so. I believe that GPs, whether fund holders or not, recognise, like everyone else in the NHS, that Labour's plans to turn all the reforms upside down and to throw away all the gains that have been made in the past three years are the last thing that the service needs. The hon. Gentleman can commit no more money. All he can commit himself to is undoing everything that has been achieved in the past three years.

To ask the Secretary of State for Health what assessment he has made of the adequacy of the internal market as the mechanism to determine the future pattern of health services in London.

Information derived from the national health service internal market on general practitioner and patient preferences and on comparative costs will help the service to plan sensibly for the future, in London as elsewhere.

Is the Secretary of State prepared to recognise that the Government's reforms have added to the difficulties of health care provision in the capital? Will he confirm or deny that the Tomlinson inquiry is likely to show that two directly managed units and one trust are in serious trouble? May I beg him to stop making political capital out of the health of the citizens of the capital and concentrate on the real issues?

Putting around scares such as that, which have no foundation in fact, is the worst kind of playing politics with health. The Government were the first to undertake the far too long postponed replanning of services in London. That was why I appointed Sir Bernard Tomlinson. I should have thought that the hon. Gentleman, who cares about these things, would welcome that. It goes as far back as to when Lord Ennals was Secretary of State. All those years ago he knew things and said that services should be replanned in London, but did nothing whatever about it.

Is my right hon. Friend aware that the need for a review in London goes back much further than Lord Ennals? My right hon. Friend's agreement to such a review and initiative is greatly to be welcomed. Will he ensure that in the review by Sir Bernard Tomlinson, the key point about London—its specialist abilities serving constituencies such as mine in Northampton—remains a focal point? I visited the neurology department at the Middlesex hospital this morning. Such services, which are available to my constituents and others elsewhere in the country, are vital for the future of our health service.

I agree with my hon. Friend. Many people within those marvellous specialist services in London believe that attracting patients from around the country, and the money that will come with them as the reforms develop, will strengthen those outstanding services. For example, many people at the Royal Brompton and National Heart hospital tell me that some of the special health authorities should be allowed to win new patients and the money that comes with them by being allowed to work in the internal market. There is no contradiction between paying tribute to those specialist services in London and pressing ahead with the reforms.

The Secretary of State said that the internal market was sensible. Does he regard as sensible the position revealed by Graham Jackson, the cardiologist at Guy's opted-out hospital, where local people are unable to be treated because the local district health authority's contract has run out? Local people are left waiting while less urgent cases from outside the district are treated because they bring money in with them. Is the right hon. Gentleman aware that six local people have had to go private to avoid waiting and 40 remain on the waiting list with no prospect of being considered until the next financial year? One person has already died. Is not this a case of your money or your life in the internal market?

I am glad that the Labour party second-rate advertising agency is now writing the hon. Lady's interventions in the House. The old system to which the hon. Lady and the hon. Member for Livingston (Mr. Cook) wish to return us was far more unsatisfactory, as she well knows. Under that system budgets were given to hospitals. They ran out two thirds of the way through the year. As the hon. Member for Livingston can promise his hon. Friends nothing about money, he could not prevent that from happening if he returned to the old system. We are moving to a system in which patients are accompanied by the money to finance their treatment. That is far more sensible.

To ask the Secretary of State for Health what steps his Department has taken over the last 12 months to promote the carrying of organ transplant donor cards; and if he will make a statement.

The Department maintains a continuous campaign to promote the carrying of donor cards.

Is the availability of donor organs more of a limitation on the transplant programme than the availability of resources? Will there come a time when that might become so acute that the Minister would be prepared to consider an opt-out as opposed to an opt-in donor system? How much money has been spent in the past year on promoting the donor card, compared with that spent on the more partisan promotional material which the Government have put out on their other health policies?

We distributed more than 10 million donor cards in the past 12 months. For a long time we have made it clear that the largest restriction on the growth of the transplant programme is the availability of donated organs, although it is not a restriction which has stopped the programme in its tracks. I remind the House that 33 kidney transplants per week are now completed, compared with 16 per week in 1979, and that there are now six heart transplants and seven liver transplants every week—a total transplant programme of 46 operations every week of the year. The programme is going well, but needs to go better. The best way to further enhance it is for every citizen to carry a donor card and to ensure that their families are aware of their view that their organs should be available for transplantation after their death.

Does my hon. Friend agree that only about 60 per cent. of potential donors have organs retrieved from them? Does he agree that that is partly due to the failure of some consultants to seek organs on every possible occasion and also to the reluctance of some next of kin of potential organ donors to give their consent? In those circumstances does he think that there is a place for a new organ donor card, which has to be countersigned by next of kin? Will he consider a much stronger publicity campaign for organ donation?

My hon. Friend is known to the House to be a great expert on this issue. He is right to say that a significant number of organs, which could be used for transplantation, are not used. We are conducting some research to establish the full range of reasons why that is so. We are specifically considering the proposal that the donor card should be countersigned. I am much more sympathetic to that proposal than I am to the opt-out proposal advanced by the hon. Member for Orkney and Shetland (Mr. Wallace).

To ask the Secretary of State for Health if he will make a statement on the financial position of provider units in the NHS.

At the end of the third quarter, provider units remained on course to achieve a financial balance this year, as we had reported earlier at the end of the second quarter.

Does the right hon. Gentleman deny that there was an attempt to cover up the fact that many of those units are in serious financial difficulties? Since the matter is in the public domain, as a consequence of information from his Department reaching the public which was not intended to reach them, how does he propose to deal with the matter? What proposals has he to put before the House this afternoon?

The hon. Gentleman is heading towards a vulnerable area for the Opposition. I advise him not to embarrass his hon. Friend the Member for Livingston (Mr. Cook) in that way. The national health service is greatly improved, in that for many years—including those years when the Labour party was running, or reported to be running the country—the financial balance of the service was poor. This year we have treated many more patients than previously and the service is in financial balance. The leaked document showed only the most commonsense action by the NHS management executive to monitor those hospitals where there are problems. If the hon. Gentleman thinks that that is odd it merely shows that, in common with the hon. Member for Livingston, he has had no experience of such matters.

Has my right hon. Friend had the opportunity to read the scandalously deceitful national health service trust ballot which was put through my constituents' letter boxes by Labour-controlled Harlow council—at an expense to the charge payers of £25,000? Is my right hon. Friend at all surprised that the local health authority wants nothing to do with that document because it is pure Labour party propaganda and a cynical manipulation of the elderly and the frail? Will Labour stop at nothing to grab a few cheap jokes?

I had the opportunity to study the document because my hon. Friend drew it to my attention as we came into the Chamber. It is a classic example of the waste of local taxpayers' money by a foolish council which would do much better to spend the money on the services for which it is statutorily responsible.

How does the Secretary of State square his answer to my hon. Friend the Member for Midlothian (Mr. Eadie) that provider units are in balance with the evidence from the document, which he knows well, that 86 hospitals are in deficit? Many of them face major cuts to balance at the end of the year and one of them has dangerously low nursing levels. How many hospitals, such as Watford, have big deficits? How many health authorities, such as Tunbridge Wells, cannot pay for routine operations and how many district health authorities, such as South Birmingham, cannot pay any more bills until April? Is the reason that the Secretary of State objects to the leak that the document tells the truth about those hospitals and exposes his cover-up?

The hon. Gentleman is a bit confused. If 86 hospitals have some problems, it means that another 500 do not. Some of those 500 are in surplus and, as the health service is a unified service, those surpluses can be transferred to deal with the problems. There is nothing astonishing about that.

To ask the Secretary of State for Health if he has monitored the extent to which people over 60 years are having their eyes examined since 1989 compared with previous years; and if he will make a statement.

Surveys carried out by the optical profession show that after an initial drop, 12·43 million sight tests were carried out in the financial year ending 1991. This exceeds the 12·21 million sight tests in 1987—the last typical year before the changes to the system were announced.

I am grateful to my hon. Friend for those figures, which I shall study carefully. In view of the fact that eye testing is important in picking up illness in the elderly and that we are in the business of preventive medicine rather than treating illnesses when they occur, will my hon. Friend keep an open mind? Should the figures for the number of eye tests show an adverse trend compared with those of the past, will my hon. Friend consider the possibility of reintroducing free eye testing for the over-60s?

My hon. Friend is right to emphasise the importance of prevention. That is why the work of general practitioners is important in terms of the regular checks that they carry out on their patients, in particular those patients aged over 75. I can tell my hon. Friend that four out of five of those elderly patients have accepted their check-ups and that nine out of 10 found them useful.

For 40 years the policy has been that some contribution should be made towards the cost of sight and dental charges—that was agreed by both parties. People pay 13p a week towards the cost of a sight test every two years—less than the cost of a second-class stamp.

Is the Minister's very carefully worded reply an attempt to distract from the fact that the proportion of the elderly in the population is increasing and will continue to do so? Therefore, the potential demand for eye tests from the over-60s will increase exponentially. We have received clear evidence from opticians in our constituencies that the imposition of charges runs contrary to the concept of preventive medicine. That move was further encouraged by the increases in prescription charges last week, which were above average when set against inflation. Should not the costs of check-up tests and the associated costs be scrapped?

The hon. Gentleman, when discussing the increase in prescription charges, did not, of course, mention the above-average increase in optical vouchers—a 9·5 per cent. increase. As the population becomes older, it also becomes wealthier and I draw the hon. Gentleman's attention to the fact that the average pensioner has increased his or her income by 33 per cent. That contrasts with the time when Labour was in power when pensioners' incomes increased by a modest 3 per cent.

The importance of prevention has been emphasised time and again. That is why, only last year, we were involved in the eye awareness campaign with the profession to draw attention to the importance of people ensuring that their eyesight is checked.

Is my hon. Friend aware that there was a serious fall-off in the number of people presenting themselves for eye tests for a considerable period after the charges were introduced and that the current figures show that we have not yet made up that gap? If that is not so, why have so many ophthalmologists gone out of business?

I regret that I disagree with my hon. Friend, but I assure her that the levels have returned to those of 1987. That is agreed by the professions, with which I shall be having further discussion shortly. It is important to note that we have greatly increased the number of professionals providing services on a wide range of fronts. For example, there are an extra 22 per cent. ophthalmologists and an extra 22 per cent. optometrists registered with family health service authorities over and above the 1979 figure. They are all providing an excellent service. I am also pleased to inform my hon. Friend that ophthalmology waiting lists have fallen substantially during the past year.

Is the Minister aware that the number of eye tests in the Oldham area dropped by one third last year? Is he aware that even when people are examined, are found to have cataracts and wait a long time for the operation, some of them—such as a 91-year-old constituent of mine—are told that Royal Oldham hospital, which has been granted trust status, does not have the money to provide the necessary medicines and has money to help only the elderly?

I am extremely surprised to hear what the hon. Gentleman says, for opthalmology waiting lists between March 1990 and March 1991 almost halved for long waiters. There is in the patients charter a clear commitment that patients should be seen within a maximum of two years. I shall look into the circumstances that the hon. Gentleman describes. Free NHS sight tests are available to those on low incomes, children and those especially at risk of eye disease, such as glaucoma sufferers. About 40 per cent. of people are entitled to free tests.

To ask the Secretary of State for Health what proportion of general practitioners in Redbridge are reaching the 80 per cent. target for immunisation and cervical smears; and if he will make a statement.

On 1 April 1991, 65 per cent. of GPs in Redbridge and Waltham Forest were entitled to receive target payments for childhood immunisation, compared with 52 per cent. 12 months earlier. On the same date, 75 per cent. of local GPs were entitled to receive target payments for cytology, compared with 42 per cent. in the previous year.

Is my hon. Friend aware that the hon. Member for Livingston (Mr. Cook) and I have something in common? Although I do not share the hon. Gentleman's rather seedy taste for handling stolen goods, I did believe, as did he, that the 80 per cent. targets were too heroic and would never be reached. I was wrong, and they have been a dramatic success. Will my hon. Friend call on the hon. Member for Livingston to make a similar admission of the error of his ways?

I congratulate my hon. Friend on accurately quoting the words of the hon. Member for Livingston (Mr. Cook) on 25 July 1989, when he described the targets as

"so heroic … that many doctors will … give up trying." —[Official Report, 25 July 1989; Vol. 157, c. 910.]

Far from giving up trying, doctors are meeting the targets. I have further bad news for the hon. Member for Livingston. He may remember that at about this time last year we published a series of figures which demonstrated that his predictions were wrong. He will not have long to wait for another diet of his own words.

To ask the Secretary of State for Health when he next intends to discuss doctors' contracts with the British Medical Association; and if he will make a statement.

Ministers meet BMA representatives regularly to discuss a range of issues.

In view of the evaporation of the objections of the BMA and a large number of doctors to the Government's policy, does my hon. Friend agree that the debate is being drawn up along the following lines, with the Confederation of Health Service Employees, the National Union of Public Employees and the Labour party on one side and the Government, the taxpayers and the patients on the other? My hon. Friend is aware that junior hospital doctors' hours have been a matter of concern for many years. Will she do more to publicise the results of the recent negotiations on that issue?

My hon. Friend is right to say that the Labour party is increasingly losing credibility with patients, the public and the NHS staff because we are seeing concrete achievements by the NHS as the reforms work out in practice. We frequently talk with the BMA about junior doctors' hours. We have agreed to a new deal, with £60 million extra going in to tackle the problems of junior doctors and 500 extra staff. Moreover, we have agreed in full to the pay review body's recommendations on how to fund the doctors' new contracts. Shortly, we shall launch a further information campaign because, to achieve the changes in junior doctors' hours, it is important that the NHS task forces in each region can work with the juniors, managers and consultants to find practical solutions at their particular places of work. We believe that we have seen the end of that problem. We must complete that process.

Does the Minister realise that there is great disquiet among doctors about the slow implementation of an improvement in their hours and conditions? In that context, will she look at the pooling system that applies to GP contracts, because many GPs have improved their work in terms of cervical smears and other tests in preventive medicine, but have ended up worse off as a result?

The number of hours a week worked by juniors has come down by about 10 hours since the Labour party was in power. In the past year, the number of those contracted to be on duty for more than 83 hours has halved, but we must go much further. Above all, we must move junior doctors on to a shift system so that they do not work more than 60 hours, coming down to 56 hours in the most intensive posts. We now have an agreement from all those concerned—the colleges, consultants, juniors and the health service—and we must find practical arrangements in each working unit to complete the task.

To ask the Secretary of State for Health if he will make a statement on progress towards obtaining the use for the NHS of the premises of the RAF Princess of Wales hospital, Ely.

I am pleased to tell the House that Cambridgeshire health authority and the Ministry of Defence have agreed in principle that the health authority should buy the RAF hospital at Ely. The health authority and the Defence Land Agent hope to conclude negotiations within a month.

For my constituents in Ely and the surrounding area, it will be excellent news that, after 52 years as part of the RAF, the hospital has a future as part of the NHS. Will my hon. Friend join me in paying tribute to the sterling work done by the Action Committee for a Hospital in Ely and Cambridge health authority, which persevered in trying to get the hospital for the NHS? Can he give the House any information about how it has been possible for the NHS, which is supposedly starved of funds, to find the money to buy that hospital?

My hon. Friend is right to draw attention to the fact that the further substantial increase in the NHS's capital budget in the next financial year has made it possible for the health authority and the Ministry of Defence to come to an agreement on that issue. I am glad to join my hon. Friend in congratulating those local people who have argued the strong case for ensuring that the hospital facilities at that building continue to be provided to the people of Ely. I welcome the fact that it is part of a continuing development of community hospital and community health facilities within the modern national health service.

To ask the Secretary of State for Health what remedies are available to NHS patients or their families to use if they are dissatisfied with the treatment given in NHS hospitals.

Directions issued under the Hospital Complaints Procedures Act 1985 require all NHS hospitals to make formal arrangements for dealing with complaints and for publicising those arrangements. Under the patients charter, NHS complaints procedures will be extended to all hospitals in which NHS patients receive care.

May we have an urgent inquiry into why, over the past three years, the number of complaints against the health service in Lewisham and North Southwark has gone up by 100 per cent., why there have been 30 complaints already this year and why serious complaints of maladministration and negligence have been made against Guy's, King's College and St. Thomas's hospitals by my constituents over the past year? Why, even when complaints are made, are they often inadequately dealt with, why is there no compensation and why do people sometimes hear nothing for far too long?

The increase in complaints may have something to do with the fact that we believe that it is important that if someone has not received the care to which he thinks he is entitled from the NHS, his right to complain should not be a well-kept secret, as has too often happened in the past. A patient's attention should be drawn to the fact that he has a right to complain and we have taken steps to do so. We take each complaint seriously and seek to ensure that every one is properly examined. I look forward to hearing from the hon. Gentleman how he will deal with the complaints that I expect he will receive from his constituents, when he has to explain to those employed at Guy's hospital why the Labour party's policies would deny that hospital the opportunity to increase staff pay by £6 a week.

Will my hon. Friend accept the thanks of the House for the award of compensation to those patients who contracted HIV as a result of blood transfusions in the NHS? Will he pass on the thanks of those of us who went to see the Prime Minister two weeks ago to ask for his help in the matter?

I am grateful to my hon. Friend for his comments. We concluded, after long and careful thought, that it was right to make the change that we announced earlier this week.

Is the Minister aware that medical accidents constitute a major cause of dissatisfaction? The legal procedure is far too clumsy and hit-and-miss. Cannot we have a proper system of no-fault payments for medical injuries?

The House debated the issue about a year ago and reached the conclusion, on a free vote, that that issue was not the highest priority call on the NHS budget. I agree with that decision and would not commend any proposal to change it.

To ask the Secretary of State for Health how many in-patients are waiting for longer than a year for treatment; and what was the corresponding figure for 1979.

At March 1979 the number of in-patients waiting over one year was 185,195. Provisional figures show that by December 1991 the number had fallen to 108,982, a reduction of 41 per cent.

Those figures are welcome, as is the 60 per cent. reduction in the northern region of those having to wait more than two years. Is not the essential difference between Government policies and those of the Opposition that the Government's prime concern lies with patients' interests, while Opposition Members' prime concern is to keep happy the unions that pay and sponsor them?

I fear that on health, as on other issues, that is all too true. I think that the House will unite in applauding the fall in long waits. Our congratulations should go out from the House to the national health service for what it is achieving.

The policies of the Secretary of State have meant that patients who have waited too long find the lists abolished, as happened to the varicose veins list at Whipps Cross hospital. As South East Staffordshire health authority has drawn attention to the longest waiters—[Interruption.]

I did not hear the intervention, but hon. Members should keep quiet.

Thank you, Mr. Speaker. As South East Staffordshire health authority has said, attention to the longest waiters

"does not equate to attention to clinical priorities."

Is the Secretary of State more concerned with patients on waiting lists or with headlines on waiting lists?

Like the hon. Member for Livingston (Mr. Cook), the hon. Lady leads for the Labour party in a weak suit. It is not just long waits that are falling. As she probably knows, half of all patients are treated as emergency cases, half come from waiting lists. When the Labour party was in power, half of the remaining half—the other 25 per cent.—were admitted in, on average, eight weeks. We have reduced that period to five weeks, which means that millions of patients now wait for shorter periods than they did under a Labour Government.

We are told by The Observer that the hon. Member for Livingston is now running as part of a comic team with the hon. Member for Kingston upon Hull, East (Mr. Prescott)—a wonderful pantomime horse—in seeking the job of the Leader of the Opposition. If the hon. Member for Livingston ever got into power, no doubt we would return to the longer waits that we experienced under the Labour Government.

To ask the Secretary of State for Health how many representations he has received from patients about NHS trusts; and if he will make a statement.

I am delighted to report that a recent patient satisfaction survey showed that, of 901 patients consulted, 96 per cent. were either very satisfied or quite satisfied with the quality of service that they had received. The survey showed also that the majority, 92 per cent., felt that the service had improved or stayed the same.

Will my hon. Friend take time today to congratulate the doctors and staff at Ormskirk district general hospital who are second in the country in respect of their waiting list register, with 94 per cent. of patients operated on within three months of their names appearing on the register? The hospital, driven by the doctors themselves, is seeking trust status; I hope that my hon. Friend will consider its application sympathetically and support the hospital in every way that she can.

I give my warmest congratulations to the staff at Ormskirk hospital, which I visited in November 1989 for the turf-cutting for a new £32 million project which was a typical example of the 75 per cent. increase in capital spending that we have put into the service—unlike the cuts of the Labour party. The hospital has certainly achieved remarkable developments and was recently congratulated by the Sunday Times on its work in having achieved the second shortest general surgery waiting list.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 February.

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.

With only a few more bribing days left before the general election and in view of the fact that the House has been televised for more than two years, will the Prime Minister tell us whether he is prepared to take part in televised debates during the general election campaign with the Leader of the Opposition—yes or no?

As the hon. Gentleman knows, we hold televised debates in the House twice a week—

Frit!

Order.

Has my right hon. Friend had a chance to study the statement by the Bundesbank that Germany is now in recession and that it blames the fall in output in Germany on the world recession? Does not that nail the lie being put around that these circumstances are due not to world but to British recession?

As my hon. Friend points out, the Bundesbank has said that the German economy is now in recession. That confirms the point that I have been making to the House for some time about the international slow-down and international difficulties. A number of countries are either in recession or experiencing a slow-down in activity. Germany, alas, is the latest country to reach a formal recession.

Would the Prime Minister confirm that today's figures show the biggest rise in long-term unemployment in 10 years, that 1·3 million people in Britain have been without work for more than six months and that 750,000 of those have been without work for more than a year? Against that background, does the Prime Minister still dare to say to those people and their families that their prolonged misery is a price well worth paying?

No one has said that, as the right hon. Gentleman well knows. This month's increase in the numbers unemployed for a year or more is certainly extremely unwelcome, but the long-term unemployment level is about half what it was five years ago and long-term unemployment among 18 to 24-year-olds is also half that level. Long-term unemployment among the over-50s has halved over the past four years. These figures are too high, but the only way to get them down permanently is to have the right structure of development in the economy: low inflation and stable exchange rates. That is what we are providing; there is no easy way.

But the Prime Minister and the Chancellor have said that this unemployment and recession are a price well worth paying. Can the Prime Minister really take any comfort from the fact that, bad as today's figures are, they are slightly less bad than they were in the last Tory slump? Is he really trying to convince the people of Britain, as they tried to do then, that policies of this kind provide a basis for sustained recovery and sustained growth? British unemployment is rising faster than unemployment in any country in the rest of the European Community. We have a huge increase in long-term unemployed, and more job losses are being announced every week. All this is taking place while the Prime Minister has had his present job and while he was Chancellor of the Exchequer. Is not it now obvious that Majorism is not working?

I repeat to the right hon. Gentleman that I have said no such thing, and neither in context has my right hon. Friend the Chancellor. As I said a moment ago, there is only one way to create long-tenn stable employment. The right hon. Gentleman implies that nothing is being done. I do not call halving inflation doing nothing. Last month it fell to just over 4 per cent. If that is doing nothing, what were the last Labour Government doing when inflation went up to 27 per cent?

The Prime Minister cannot correct the record to the extent of pretending that both he and the right hon. Member for Kingston upon Thames (Mr. Lamont) have not said that today's conditions, with all their misery, are not a price well worth paying. That is the first point. Secondly, the Prime Minister refers to the record over 13 years. In that 13 years manufacturing output under his Government in Britain has gone up less than 6 per cent. It has gone up by four, five and 10 times as much among our competitors, and the right hon. Gentleman is still not doing anything to bring Britain out of recession, to give us recovery. A Tory Government means permanent high unemployment.

The right hon. Gentleman does not listen and he does not understand. I repeat: I have said no such thing and I invite him to withdraw. The House will know that he changed his allegation between his first and third questions. If he is really concerned about unemployment, why does he want to cripple British industry by bringing back flying pickets, by encouraging mass pickets, by returning trade union immunities, with all the difficulties that we saw in the 1960s and 1970s? That would not produce growth and jobs. That would produce permanent slump, no jobs, no prospects, no hope for the future. Those are the policies that the right hon. Gentleman sets out before this nation.

Does my right hon. Friend recognise that the decision to compensate those who contracted HIV as a result of treatment through the national health service is widely welcomed? I thank him for a speedy and compassionate response. He knows the representation that I made with other colleagues only a fortnight ago.

I am grateful to my hon. Friend for what he says. We made special provision for those with haemophilia and HIV because of the special circumstances that are apparent and because of the widespread representations that have been made to us. I hope that it will ease the difficulties of people who face such a tragic circumstance.

Does the Prime Minister realise that there are only two facts that one needs to know to assess the Government's real commitment to recovery? The first is that unemployment rose by 53,000 last Thursday and the second is that the Government cut their training budget by £171 million last Friday. How does the Prime Minister justify that?

The right hon. Gentleman is well aware that we have the largest training provision that this country has ever seen. If the right hon. Gentleman does not know what circumstances are necessary for long-term prosperity and jobs, and that they are basically low inflation and a stable economy, he ought to learn that speedily.

When my right hon. Friend is making arrangements for his business in the second week in April, will he please include a visit to Edgware general hospital, where he will find patients, members of staff and doctors highly satisfied with the changes that have taken place in the national health service?

I shall be happy to visit that hospital. I think that the changes in the health service are increasingly being understood to be welcome and to be providing a better health service for the future. That is becoming increasingly understood within the health service—if not, alas, on the Opposition Benches.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 February.

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

The Government have increased prescription charges 14 times, and they did so just this week by twice the rate of inflation. Will the Prime Minister intervene to stop this disgraceful taxation of the sick—yes or no?

There are 100 million more free prescriptions this year than there were at the time of the last Labour Government. The number of people who pay for prescriptions has shrunk and shrunk, as the hon. Gentleman knows. He should stop trying to misrepresent policies.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 February.

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

Will my right hon. Friend agree to visit Basildon—[Interruption.]—

Order. Come on.

—the finest and most exciting town in the country? When my right hon. Friend does so, will he tell my constituents that there has been a record reduction in the number of strikes and that we now have the best figures for decades? Does he agree that such improvements are a key component in a strong economy and that they have been achieved through the Government's industrial relations laws, which the Opposition parties wish to repeal?

I shall be happy to visit my hon. Friend at Basildon either before or after the general election. He makes a good point. Indeed, the figures for 1991 are even better than those for 1990. There were fewer strikes last year than in any year since records began a century ago. That is essentially because of the change in labour relations and the encouragement that has been given for employers and the work force to work together.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 February.

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

Has the Prime Minister seen the prospectus from Pathfinders Repossessions plc, which is a company which proposes to buy repossessed homes at auction and then flog them off or rent them at a huge profit? I understand from the promoters that the project cannot fail because it qualifies for tax reliefs under the business expansion scheme. Does the Prime Minister find this proposition just plain squalid?

The straight answer to the hon. Gentleman is no, I have not seen that prospectus. If the hon. Gentleman had wanted a detailed comment on it, he would have invited me to look at it before he asked his question. [Interruption.]

Has my right hon. Friend had the chance to study the document entitled "The Citizen's Charter", which was written in 1921 by Herbert Morrison, then secretary of the London Labour party? It states that the best way to improve public services is to increase competition. Does not that show that no amount of tacky red plastic roses, sharp suits and slick public relations can disguise the fact that, far from progressing, Labour is regressing?

I believe that it does show that. My hon. Friend is entirely right about the merits of competition. We now have another citizens charter that addresses the direct problems faced by the people of this country. The Opposition are so rattled about it that NALGO is spending £2 million to advertise against it.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 February.

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

The Prime Minister does not seem to be aware of what is happening with prescription charges. May I draw to his attention the case of a constituent of mine, a Mr. Russell, who is paid just 6p more than the income support level? From 1 April, he will have to pay £3·75 a week for a prescription out of an income of £60·31. If that is not a tax on the sick, will the Prime Minister tell us what it is?

One in three people are now entitled to free prescriptions, as opposed to one in six. There are far more prescriptions than ever before for which people no longer pay, and those who find themselves marginally above income support level have the option of acquiring a season ticket precisely to meet that problem.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 February.

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

Does my right hon. Friend agree that the Prevention of Terrorism (Temporary Provisions) Act is an essential weapon in the battle against terrorism? Does he agree that all parties in the House should support its annual renewal, so that we can send the terrorists the clear message that they can never win?

Yes, Sir—and I believe that recent events reinforce that point. Without the renewal of the Act, the IRA would be free to march, recruit and raise funds anywhere in Great Britain. Its renewal is absolutely essential, not just as a clear message to the terrorists but as a vital part of our ability to safeguard the lives of our citizens. I hope that, in the light of all that has happened, the Opposition will change their policy on this occasion, and will support the renewal of the Act.

The motion in the name of Mr. John MacGregor. Not moved. I call Mr. Andrew F. Bennett.

On a point of order, Mr. Speaker.

Well, we have rather passed points of order.

On a point of order, Mr. Speaker. The Prime Minister said in reply to my right hon. Friend the Leader of the Opposition that neither he nor the Chancellor had made the remark about unemployment being a price well worth paying. May I tell you and the House, Mr. Speaker—

Order. The hon. Gentleman's point of order constitutes a clear continuation of Question Time. I am not responsible for what the Prime Minister has said.