To ask the Secretary of State for Health if he will make a statement on the effectiveness of the general practitioner service. [7942]

We have one of the finest family doctor services in the world, largely thanks to the professionalism and commitment of our general practitioners and the members of their primary health care teams.

Where people do not have access to the range and high quality of services that they deserve, we shall work with primary care professionals to explore better means of delivering services. We shall also rid the NHS of the excessive bureaucratic demands and inequities of the internal market.

I recognise that there have been some minor difficulties with GP fundholding, but does the hon. Gentleman recognise that the system has put general practitioners on a par with consultants and enabled them better to reflect the clinical needs of their patients? What consultations have taken place already about the change of policy? Will the hon. Gentleman give us an assurance that he will consult family doctors further to ensure that the benefits of the system are not discarded—in other words, that we do not throw the baby out with the bath water?

I have to tell the hon. Lady that there are more than minor problems with the GP fundholding system. Of course I recognise the importance of the need for GPs and other primary care professionals to play a leading role in the commissioning of health care, but the hon. Lady and her party must acknowledge the fact that GP fundholding has brought with it a two-tier system of health care, which runs against the grain of the principles of the national health service, as well as being bureaucratic and costly.

As for consultation, we are prepared to consult all primary care professional organisations. I am pleased to say that the British Medical Association, the Royal College of Nursing and other organisations have acknowledged and supported the announcement that the Government made last week.

Does my hon. Friend agree that the general practitioner service is greatly enhanced by the services of health visitors, school nurses and the chiropodists who give treatment to the elderly? Does he acknowledge the distress caused in Cambridgeshire by the cuts imposed on those services by the Cambridge and Huntingdon health commission?

I am aware of my hon. Friend's concerns, and those of other hon. Members, about the cuts in primary and community care services. Of course that is an issue that we shall have to monitor closely. One of the initiatives that we have already undertaken is the piloting of new arrangements for the delivery of personal medical services that will better integrate GPs and other primary care professionals in future, so as to ensure better delivery of those services.

To ask the Secretary of State for Health what proportion of national health service staff are directly involved in patient care. [7943]

Just under two thirds of national health service staff in England in 1996 were classified as direct care staff. That figure is based on the definition used by the previous Government, which included some staff who were not directly involved in patient care and excluded some staff who were.

Will the Secretary of State confirm that the proportion of NHS staff directly involved in patient care increased from 60 per cent. in 1981 to nearly two thirds—the figure that he has just given me—under the Conservative Government? What will his target be for five years' time?

As usual, the statistics produced by Tory central office do not compare like with like. There are now more administrative staff in the health service than ever. There was a 44 per cent. increase between 1986 and 1995, and between 1990 and 1996 the wage bill for administrative staff rose by £700 million. That may be one explanation of why the hon. Gentleman's local health authority entered this year—under the previous Government—£2.1 million in debt.

I agree with my right hon. Friend that one of the worst aspects of the previous Government's health reforms was the bureaucratisation of the health service; far too few staff were engaged in direct patient care and it is a considerable tribute to them that they have none the less been able to cope and provide an excellent service. Will he comment on the fact that, despite those efforts, staff have all too often to work in outdated hospitals and unsatisfactory environments? That problem, in Birmingham and elsewhere, was not addressed by the previous Government. Will he ensure that the present Government address it?

I give my hon. Friend the assurance that he seeks. Besides increasing the number of staff exclusively involved in paperwork, the previous Government's reforms massively increased the time that doctors, nurses and other professionals had to devote to paperwork to feed the general bureaucratic system.

Is the Secretary of State aware that nurses at the accident and emergency unit at St. Helier hospital in Carshalton, who are directly involved with patient care, are currently balloting for industrial action because of concerns about the quality of patient care at the hospital? Does he have any plans to take action to ensure that the threat of industrial action is averted?

The situation arose under the existing management of the St. Helier hospital and must be sorted out by that management.

Has my right hon. Friend seen a recent survey that shows that some doctors, at least, are not as involved with patient care as they should be? In that survey, published in the British Medical Journal, an astonishing number of junior doctors say that they performed their first operation unsupervised. Is not that extremely alarming for patients? Is not it a good job that patients do not know that? Will my right hon. Friend examine the matter?

We must certainly ensure that clinical standards in hospitals are raised rather than lowered. There is no possible excuse for junior doctors conducting their first ever operation without proper supervision. It is necessary for junior doctors to perform operations, however, otherwise they will never become sufficiently skilled to work on their own, but they need to be supervised while they are doing it.

Is the Secretary of State aware of any occasion on which the Prime Minister has spoken of health service managers with appreciation, or even respect? Can he imagine circumstances in which, at the taxpayer's expense, he would host a glitzy reception at No. 10 to celebrate their contribution to the public good?

My right hon. Friend is certainly extremely unlikely to host a glitzy reception at No. 10 to celebrate the right hon. Lady's contribution to the national health service. At the National Association of Health Authorities and Trusts conference last year he paid tribute specifically to the excellent managers in the NHS. He certainly does not pay tribute to the enormous increase in paperwork that occurred at the Department of Health when the right hon. Lady was supposedly in charge.

To ask the Secretary of State for Health what measures he proposes to take to ensure that national health service dentistry is available in south Shropshire. [7944]

To ask the Secretary of State for Health what proposals he is assessing in order to improve access to national health service dentistry. [7952]

The previous Administration's failures mean that there are problems with access to NHS dentistry in some parts of the country. I shall decide shortly on how best to use the resources available to us for improving the availability of NHS dentistry. In addition, on 1 July I announced the Government's intention to proceed with the piloting of personal dental services under the National Health Service (Primary Care) Act 1997. Those measures will help to ensure the provision of dental services that best suit local circumstances.

I do not think that my constituents in south Shropshire will be much impressed by the hon. Gentleman's attempt to shuffle off the responsibility to the previous Government, because the new Government are now responsible for national health service provision in all areas. If he wants to pick a quarrel, let me point out that my party provided 3,500 extra national health service dentists in the period 1979 to 1997. The point at issue is that it is unreasonable for my constituents in south Shropshire to have to journey to Telford or Shrewsbury for dental health treatment. Will the Minister give the House a categorical assurance that he will correct that situation?

If the hon. Gentleman wants to trade facts of the matter, I am happy to do so. The fact of the matter is that under the Conservative Government the number of adults registered in the Shropshire area for NHS dental treatment fell by more than 1,000 per month over the past year. The Conservative Government were responsible for that, not us.

The Minister knows that many people, especially new patients, have problems with access to NHS dentistry. My constituents have been concerned about that for at least the past seven years, so I do not lay the blame at the Government's door. What targets will he set so that improvement in access to NHS dentistry can be measured? Will they relate to distance travelled or to the number of dentists per 10,000 population? Can we have specific measurements of performance that we can tell our constituents to expect within a certain timetable?

We are considering two issues: how best to use the resources available to plug the gaps in provision to which the hon. Lady alludes, and how more effectively to use those resources the better to ensure the improvement of oral health. She recognises that there are major variations in oral health performance between areas. I and my hon. Friend the Minister for Public Health will be undertaking an important joint initiative to ensure that access to NHS dentistry is more widely available and that our resources better improve the oral health of the population.

Does not it take enormous brass neck for the hon. Member for Ludlow (Mr. Gill), 11 weeks into a new Labour Government, to ask a question about NHS dentistry when, according to the Library, he has not asked a question on dentistry in the past two Parliaments, going back to 1987? NHS dentistry is a desert not only in south Shropshire but in places such as north-east Lancashire. Is not it time that more was put into dental services to ensure that our NHS dental service is capable of surviving after 18 years of Tory government?

My hon. Friend is right to make that point about the hon. Member for Ludlow (Mr. Gill). An announcement will be made in due course about how we intend to target the resources that we have to improve availability and the oral health of the nation.

To ask the Secretary of State for Health what estimate he has made of the financial impact of the abolition of compulsory competitive tendering in the national health service. [7945]

There is no compulsory competitive tendering in the national health service. The Government are, however, examining market testing policy, in particular the current requirement to market-test catering, cleaning and laundry services. Whatever the outcome of the review, we are committed to best value in terms of both cost and quality of service for all NHS patients.

I thank the hon. Gentleman for that excellent reply. Does he agree with the Secretary of State—[HON. MEMBERS: "Reading."] I shall quote if I may—who, in 1995, said that the benefits from compulsory competitive tendering had been made

"at the expense of blue collar workers"

and that that was why he was against it? Has he changed his mind? Does the Minister agree that competitive tendering provides an effective means of market testing? Will he confirm that it has saved the NHS £1 billion since 1993?

Five marks for artistic impression, none for substance. The hon. Gentleman is obviously unaware not just of the concerns of NHS staff and managers about compulsory market testing but of the concerns of commercial contractors. He might know of the Business Services Association, which represents leading-edge cleaning and catering companies. Its director general said recently:

"Our most urgent task is to convince the public sector that we genuinely want a partnership based on mutually compatible objectives. The confrontational approach of CCT and market-testing must be transformed into a system of co-operation between public and private sectors."

We have been listening to the private sector. Obviously the hon. Gentleman has not. I conclude from that that the Conservative party has nothing of value to say on the NHS and does not even represent the interests of the private sector, which it claims to speak for.

Will my hon. Friend explain to the hon. Member for New Forest, West (Mr. Swayne) that no hospital service survives in a clean and secure state if it is run by low-paid, disaffected and unhappy people such as the low-paid workers who provide the profits for unscrupulous private contractors?

My hon. Friend is absolutely right. Catering, cleaning and portering staff deliver part of the family of services provided under the umbrella of the NHS. They play an important role in hospitals and other settings in the NHS. The Government value and respect their contribution and we want value for money and quality of provision to go hand in glove in the future.

Is the Minister aware that an estimate produced by his Department at the end of the last Parliament suggested that the savings made for the NHS by competitive tendering were about £90 million a year? If that is added to the cost of the minimum wage that the Government propose to introduce and to the impact of inflation next year, how much of the additional £1 billion that his Department obtained in the Budget will be available for patient care?

I have a fairly simple view about statistics produced under the previous Administration—they are wrong.

To ask the Secretary of State for Health what action the Government are taking to reduce tobacco consumption. [7946]

To ask the Secretary of State for Health what action the Government are taking to reduce tobacco advertising. [7948]

The Government are fully committed to banning tobacco advertising as part of a comprehensive strategy to reduce the 120,000 deaths every year caused by smoking or smoking-related illnesses. We made clear our intention to do this in our manifesto. A summit of national and international experts was held on 14 July to examine options for reducing smoking and controlling tobacco consumption. It is essential that we get the right combination of measures rather than rely on any single measure. The results of the summit will help inform Government policy and we will set out our strategy to reduce smoking prevalence and tobacco consumption, including our plans for legislation, in a White Paper to be published later in the year.

Is my hon. Friend aware of just how badly the previous Government's strategy to control smoking among 11 to 15-year-olds failed? I am particularly concerned about young girls. Ten years ago, one in five girls aged 15 smoked—now, one in three smoke. What are the Government doing to improve that appalling statistic and to protect children from the dangers of tobacco?

The first step is to realise that young people—young women in particular—are susceptible to the influence of direct tobacco advertising and indirect advertising through sport and other sponsorship. My hon. Friend is right. If we are not successful in reducing smoking among young women, they will become young mothers who smoke and whose children will be affected.

I am sure that my hon. Friend is aware that smoking kills 120,000 people every year. That is equivalent to six jumbo jets crashing every week with total loss of life. If that happened, there would be public outrage and calls for action. What package of measures is my hon. Friend therefore proposing to adopt to tackle one of the nation's most deadly killers?

I should make it clear that the purpose of the anti-smoking summit held on 14 July was precisely to get the best possible advice about the range of measures that should be included in the White Paper that will frame the legislation to ban tobacco advertising, which will be published later this year. There is no single measure that will enable us to make an impact on those wasted deaths. We realise that it is through a combination of measures that we will achieve that end; that is why we have sought the advice of experts from around the world to ensure that we have a policy that works.

The hon. Lady is right to say that a combination of pressures is needed to stop 5,000 teenagers a week taking up smoking. Is it possible to learn some lessons from the continuing campaign to end drink-driving? Can she try to give more emphasis to the points that she used to make on radio, with some effect—if people around smokers disapprove, those smokers are far less likely to continue to smoke and if people smoke in front of those who are younger than them, the young are far more likely to copy them?

The Government will examine a range of evidence when drawing up their programme of anti-smoking measures. It is quite clear that children who are brought up in households where the parents smoke are more likely to smoke. That significant fact explains why it is also important that, through good health education in schools, we ensure that children are aware of the risks of smoking and seek to influence the behaviour of their parents.

Does the Minister propose to replace the current health warnings that appear in advertising and, if so, what is her estimate of the cost of that?

I repeat that last week's summit examined a range of measures. We will consider where we need to take further steps to alert the public to the risks of smoking. We will bring forward our proposals in the autumn.

To ask the Secretary of State for Health what action he proposes to take to speed up the national health service private finance initiative. [7947]

We have already speeded up the NHS private finance initiative. We have given the go-ahead for 14 major hospital projects and passed the first Act of this new Parliament to clear up the law on the operation of the PFI in the NHS.

Does my right hon. Friend agree that the best way to speed up implementation of the PFI in the NHS is to ensure that the 14 projects—I am happy to say that one is in my constituency—deliver what they promise? Can my right hon. Friend tell the House what steps he intends to take to monitor the progress of those initiatives and to ensure that the schemes deliver on price and on time?

I confirm that we will keep a close eye on the 14 projects to ensure that they get on with the job and stick to the agreed price and time scale. I am extremely glad that the go-ahead has been given for the south Manchester hospital at Wythenshawe in my hon. Friend's constituency.

I am sure that the Secretary of State agrees that private finance has existed in the NHS through general practitioner services because, over the years, they have invested in their premises to develop a modern and sophisticated service. Is he aware that in rural areas many of those GPs' private investments to enhance the services that they give their patients would be threatened if they lost the opportunity to dispense drugs to their patients because a pharmacy moved into the village? Many such places are at risk, including a major practice in my constituency which is under threat because a pharmacy has moved to the village. The practice could be made bankrupt as a result. Does the right hon. Gentleman agree that there is an urgent need for a review, and action, on the disparity of dispensing rules in rural areas?

I am not sure that that issue relates to the private finance initiative, but I share the hon. Gentleman's concern. We have to ensure that the health service is designed to provide the services people need in each particular locality and that we do not try to force a particular model on every part of the country.

While I accept that the fast-tracking process is a vast improvement on the PH mess created by the previous Government, will the Secretary of State say how much public capital is to be made available to help to pick up badly needed projects, such as the proposed women's hospital in my constituency, which were not selected for the fast track?

There are two points to make. We fast-tracked 14 new hospitals, so we managed to achieve in 11 weeks what the Tory party had failed to do in the five-year period since adopting the PFI approach, spending £30 million of taxpayers' money in the process. Because a scheme was not one of the first 14 chosen does not necessarily mean that it will not go ahead under the PFI. In any case, as we have made clear, more than £1 billion a year from the public sector will be available for national health service capital costs.

To ask the Secretary of State for Health what numbers of patients he expects the national health service to treat in each of the next three years. [7949]

The range of services provided by the NHS, whether in hospitals, in the community or in GP practices, and the variety of means of measurement, are such that it has not historically proved possible to arrive at a single figure for the number of patients to be treated.

Notwithstanding that somewhat disappointing answer, it is obvious that the number treated will depend on the budgets available to the NHS. In response to the hon. Member for Crewe and Nantwich (Mrs. Dunwoody), the Minister of State indicated that he would like wages in the NHS to rise. If a settlement similar to the £4 minimum wage now given to local authority workers in Scotland is reached in the NHS, what additional costs does the Minister estimate the NHS will have to bear?

The disappointment, such as it is, arises from the appalling legacy left by the Conservative Government's stewardship of the Department of Health over some 18 years. This year's Budget settlement was very good; it will seek real growth of some 2.35 per cent. as opposed to the growth anticipated by the previous Government of some 1.2 per cent. That is progress under Labour, delivered in a way that is about patient care, not about bureaucracy.

Does my hon. Friend agree that the ability of the NHS to treat and discharge patients depends on multi-agency assessments and the provision of care in the community? In that regard, the additional resources for the NHS are most welcome, but does he share my concern that, if they are not matched by additional resources for social services, we shall be in danger of riding a tandem with the risk of one wheel dropping off?

We need to make sure and we will make sure—my hon. Friend is right to say that we must make sure—that local authorities and the NHS work well together. That means making sure that resources are used as effectively as possible. We have already begun a dialogue with the Local Government Association and the NHS executive to make sure that that happens.

The Minister will be aware that, last week, there was an announcement about waiting lists. That will have a crucial effect on the number of patients who can be treated in the NHS. Can the Minister clear up some confusion caused by the announcement in respect of hospital trusts? What will happen in the case of a hospital trust that has negotiated contracts with more than one health authority? In the case of a trust that has a contract with, say, four authorities, three of which have specified a higher level of service than the fourth, can he confirm that the new arrangements will require—without the Secretary of State's prompting—that all those patients face a levelling down of service as a result of the creation of a common waiting list?

The right hon. Gentleman really ought not to believe that a Labour Government work on the same basis as the previous, discredited, Tory Government. We are concerned to level up patient care, but he thinks in terms of levelling down. The assumption he makes is totally without foundation: we will aim for the best practice and we will encourage trusts and authorities to work together to make sure that that happens.

To ask the Secretary of State for Health how much extra money was allocated to health for 1998–99 as a result of the 1997 Budget. [7951]

In the recent Budget, my right hon. Friend the Chancellor of the Exchequer announced an extra £1 billion for the national health service in England in 1998–99. That, combined with the planned increase of £775 million, amounts to an increase of 2.35 per cent. in real terms—the largest increase for the past four years.

Will the Secretary of State confirm that the Tory plans that he inherited would have meant a real-terms cut in NHS expenditure next year, thus bringing closer the Tories' long-term objective of running down the NHS into a basic safety net service for those unable to afford private care?

I can confirm my hon. Friend's point. Had we not given the extra £1 billion to the national health service next year, there would indeed have been a reduction in the amount of money spent in real terms, resulting from the budget that we inherited from the profligate Tories.

Does the Secretary of State believe that the NHS is underfunded?

Of course it is underfunded; everyone knows that. It has been underfunded since 1948.

Would my right hon. Friend care to comment on what he could have achieved with the health service if the £5 billion that has been squandered on the bovine spongiform encephalopathy crisis by the previous Government had been available to him to spend?

Indeed. I am going around the country explaining how useful £10 million will be when spent on breast cancer services—we shall announce the details on Thursday. Given the immediate benefits that will flow from just £10 million, it is almost impossible to imagine the improvements that could be made to people's health if we had access to the £5 billion that is squandered on BSE-related compensation as a result of the previous Government's stupidity.

The Secretary of State is fortunate in that this question was altered between the time of tabling and today, to ask about not this year's, but next year's, Budget. However, given that the Minister of State said a minute ago that the trouble with Tory figures was that they were wrong, will the Secretary of State come clean about the figures that follow on from the percentage figure that he gave? The increase to the health service this year is nothing and the increase next year, after taking inflation into account, is significantly less than £1 billion—right or wrong?

For a start, the Budget that my right hon. Friend the Chancellor of the Exchequer announced was basically the Budget for spending, not for this financial year, but for the next financial year—a fact that does not seem to have sunk into some people's minds. The increase that we have announced, together with the increase that was already in the Budget, means that there will be a 2.35 per cent. increase in real terms—more than twice what the Liberal Democrats promised in their election manifesto.

Does my right hon. Friend agree that, although budgets are tight, trusts are not collecting money that is owed to them? I am talking about the money that is owed to them by insurance companies as a result of road traffic accidents. What effort is my right hon. Friend making to encourage trusts to collect the many millions of pounds that insurance companies owe the NHS?

As recently as 1988, the previous Government confirmed the law under which insurance companies are supposed to pay up for the cost of treating people who suffer from road accidents. The system that was then introduced brings in practically no money, and we will change the law so that we get the money to which the public purse is entitled from the insurance companies. The amounts vary between £50 million a year, estimated by the Department of Health, and £440 million a year, estimated by the Automobile Association. I look forward to receiving the money, and I am at the moment pondering arrears.

To ask the Secretary of State for Health how many NHS in-patients were waiting over one year for treatment (a) in March 1979 and (b) in the latest month for which figures are available. [7953]

At the end of March 1979, there were 185,195 patients waiting more than a year for treatment at national health service hospitals—an increase of 24 per cent. over the previous year. The final figure for the end of March 1997 is 31,208. This represents an increase of 580 per cent. over the previous year.

Given the startling contrast between 180,000 in 1979 and 30,000 today, when does the Minister expect the Government to deliver on their manifesto promise of reducing waiting lists by 100,000? Or is it impossible to give a date, because the Minister knows that the Government's policies are a mirage and will not work or deliver reduced waiting lists? Perhaps the Minister would be better off speculating about the date when the Prime Minister will invite the Secretary of State to pay the price of the hospital pass that he gave when he appointed him.

The Government are already delivering on their manifesto promises. We said that we would cut bureaucracy: we are cutting it. We said that we would get rid of the two-tier national health service: we are. We said that we would replace the internal market: we are. No one in the Labour party underestimates the problems that we were left by the previous Government. Certainly, the Conservative party set some NHS records—record numbers of patients waiting for treatment, record numbers of health authorities in trouble and a record fall in staff morale.

My hon. Friend will recognise that the real waiting time for the average member of the public waiting for hospital surgery starts from the date of first referral by the general practitioner, not from the first consultation with a specialist. When will Labour's commitment to abolishing the bureaucracy that has been created be put into effect to eliminate that problem, to ensure that people get surgery as speedily as possible?

My hon. Friend is absolutely right. Patients judge how long it takes to get NHS treatment from the point of referral by the GP, so waiting times are high. In the short term, they are set to get higher, precisely because of the legacy that we face. We shall do all we can as soon as we can to bring waiting times down.

When will these 100,000 additional placements be dealt with by the Government? How will the Government calculate the number? Did not the Under-Secretary accept earlier that there is no way of calculating the figure? Is it not true that the Government gave a manifesto commitment that they do not know how to achieve?

I repeat, for the benefit of the hon. Gentleman, who was clearly not listening earlier, that the Government are committed to delivering, and are delivering, their manifesto commitments. The fact that we have cut £100 million from NHS bureaucracy to put it into patient care is the first sign of things to come. The second sign of things to come is the Budget announcement by my right hon. Friend the Chancellor of increased NHS spending of £1 billion in England. I remind the hon. Gentleman that the Liberal Democrats went into the general election promising to increase the NHS budget by £500 million: we have doubled that.

I assume that the hon. Gentleman took his earlier figures from the Department of Health statistical bulletin for 1997; it was good to hear him quoting the Department's statistics without rubbishing them. Will he confirm, however, that they also show that, in March 1979, 25 per cent. of people on the waiting list had been waiting for more than a year, whereas at the end of March this year, when this Government took over, the figure was down to 6 per cent.?

I can confirm that, by March 1997, there had been an increase of 580 per cent. in the number of NHS patients waiting for hospital treatment. In the year to March 1979, there had been an increase of rather less than that. We have certainly set some records concerning the NHS waiting list. [Interruption.] If the hon. Gentleman would stop chuntering and start listening, perhaps he would learn something.

To ask the Secretary of State for Health what measures he proposes to promote good health in schools. [7954]

Healthy schools will be a major target of our new health strategy for England. We will be working in partnership with the Department for Education and Employment and local authorities to promote the health and well-being of schoolchildren. A major objective will be to improve the nutritional value of school meals by introducing national nutritional standards.

I thank my right hon. Friend for that answer. It will be applauded throughout the country. Will he ensure that there is maximum co-operation among education staff, health service staff and parents at a local level in the effective promotion of our young children's health?

I can certainly give my hon. Friend that assurance. I should like at this time to pay tribute to the efforts of Derbyshire county council, in the face of all sorts of abuse from the Conservatives, in maintaining a very high standard of school meal services and trying to keep the price down. We should not underestimate the value of a decent meal for many children from deprived homes. We have now reached the stage where children are not able to wait for the school dinner in the middle of the day; some of them have to be given breakfast because they are going so short of food. As was said in the debate on the introduction of local authority provision of school meals in 1906, a hungry child cannot learn.

Can the Secretary of State tell me how much of the money that he mentioned in answer to his hon. Friend the Member for North-West Leicestershire (Mr. Taylor) will be spent on promoting health in schools in Leicestershire?

No. The hon. and learned Gentleman, who has been in the House more than 10 weeks, ought to have a rough idea of the fact that the amount of money that will be spent in schools in Leicestershire will, generally, be determined by Leicestershire county council, Leicester city council or—I believe—even Rutland council. We are determined that there will be national nutritional standards which all authorities will have to reach. One of the meanest, nastiest acts of the previous Government was to take away those national nutritional standards, undermining the health of tens of thousands of the poorest children in the land.

Is my right hon. Friend aware that, because of the weather, one of the problems facing schools this summer is a plague of nits in young children's hair? It may not be a problem for him or me, since there is no hair to hide in. From talking to many head teachers, it is apparent that the problem has arisen because the school nurse became an almost extinct species under the previous Government. Will my right hon. Friend talk with our right hon. Friend the Secretary of State for Education and Employment to see what can be done to ensure that school nurses are brought back and children's hair is properly examined? [Interruption.] It is a serious problem, despite the laughter of Opposition Members.

I can confirm to my hon. Friend that our hon. Friend the Minister for Public Health is discussing with the chief medical officer and others what we do at a local level to promote public health and, in particular, give not just the necessary health advice but health help to schools so that the nit nurse reappears.

The right hon. Gentleman would doubtless agree that he hopes that the Government's commitment to ban tobacco advertising will play its part in promoting the health of young children. If that is so and if tobacco is as bad as we have heard today, should not the Government seize the moral high ground and ban it completely—or is his right hon. Friend the Chancellor simply too addicted to the revenue from it?

The hon. Gentleman gets worse. I think that everybody in the country recognises that banning tobacco is not a practical proposition, because of all the consequences that would flow from it. Nevertheless, we have an obligation to try to stop the tobacco companies—which kill 120,000 of their customers every year—targeting their advertising on children so that they can recruit another 120,000 people to kill off a few years later.

To ask the Secretary of State for Health what action he is taking to promote local health strategies to improve public health. [7955]

Our strategy for public health recognises that we must operate at three levels if we are to make a real impact. First, Government must do those things that only Government can do. Secondly, individuals must make informed choices about those aspects of their life styles that influence their health. Thirdly, at a local level, health and local authorities must work together and with business, schools and the whole range of local stakeholders to deliver local targets within the framework of a national strategy.

Is my hon. Friend aware that, according to the Confederation of British Industry, more than 187 million working days were lost in 1996 due to sickness and ill health, which cost the country £12 billion? In my constituency, local businesses have worked with Warrington Community Healthcare NHS trust to develop a healthy businesses initiative and promote health care for their employees, which includes screening for visual display unit users, health and sickness screening and first aid training to improve workplaces. What can my hon. Friend do to spread that good practice across the country and ensure healthy workplaces for all?

I thank my hon. Friend for that question. I would be most interested to receive further information about the local initiative that she describes, as a major part of our public health strategy will be the development of healthy workplaces and working with businesses and industry to make the business case for public health.

Does the Minister accept that one of the most important parts of any local health strategy is the relationship between social services and local health authorities? Is she aware that, at any one time, between 10 per cent. and 20 per cent. of beds in the Horton general hospital in Banbury are blocked by patients waiting for care in the community funding? That exacerbates the hospital's budget problems and, as a result, 12 surgical beds and a day hospital for the elderly were closed yesterday. Will the hon. Lady conduct a survey across the country to determine how many beds are blocked by patients awaiting social service funding for care in the community?

Once again, a Conservative Member abdicates any responsibility for the circumstances of the past 10 years that have created the situation that he now regrets. We believe that local partnerships are essential, and we are concerned to see that the responsibilities of health authorities and local social services authorities are discharged properly. However, our local initiatives will embrace a far wider range of organisations to combat deprivation and meet our election commitment to tackling the root causes of ill health.

To ask the Secretary of State for Health what changes he proposes to make to "The Health of the Nation" strategy. [7957]

The previous Government's health strategy had some merits, but focused far too much on personal life style issues. We shall shift the balance in order to tackle the root causes of ill health, such as air pollution, poor housing, unemployment and low wages.

I am delighted to hear that there will be changes to "The Health of the Nation" strategy, because it did not make sufficient allowances for the consequences of poverty and bad social conditions—both of which increased so much under the last Government—for health. However, will my right hon. Friend assure me that we will not throw out the baby with the bath water? A strategy of targeting is useful in bringing resources to crucial areas—particularly in primary care—and it is a valuable instrument in popular health education and in strengthening personal responsibility for attaining those targets.

I agree entirely with my hon. Friend. It is true that national targets tend to obscure what goes on locally, so we need local targets as well. It is true also that we are dealing with some of the major sources of ill health among the most deprived people in England by improving and building new houses through the release of capital receipts from the sale of council housing, by creating jobs that will be funded from the windfall tax and by tackling the health problems that result from dependency on low wages through our proposal to introduce a national minimum wage—which is always readily condemned by Conservative Members, who do not give a damn about the health of those who are worse off.

To ask the Secretary of State for Health if he will make a statement on the rates of (a) stillbirth and (b) mortality amongst (i) manual and (ii) non-manual groups in the last year for which figures are available. [7958]

In 1995, stillbirth rates for all registrations where manual or non-manual status could be assigned were 5.9 per 1,000 total births among manual groups and 4.5 per 1,000 total births among non-manual groups. Rates were thus more than 30 per cent. higher in manual groups.

The most robust figures for similar comparisons of overall mortality relate to men of working age. Over the period 1991 to 1993, death rates among men aged 20 to 64 were 524 per 100,000 in manual groups and 325 per 100,000 in non-manual groups. Rates were thus more than one and a half times higher in manual groups.

Does my hon. Friend agree that those are shocking and persistent inequalities and that we are reaching the end of 20th century, not mired in the Victorian era? Does he further agree that those terrible figures are a result of the policies of poverty, unemployment and deprivation promoted by the previous Administration? Furthermore, what strategies does he have to deal with them?

I agree with my hon. Friend on all counts. I am happy to give what assistance I can. We are concerned to attack the root causes of deprivation and disadvantage. The proposals of my hon. Friend the Minister for Public Health will make a good start in that direction. We are determined to address the whole needs of the whole nation, in marked contrast to Opposition Members.

Will the Minister also look at the way in which provision for services provided by the professionals who are most concerned with these ghastly figures is targeted in the areas where it is most required? I am thinking of health visitors, district nurses and school nurses.

I very much share the hon. Gentleman's concern. In terms of the preparation of women who are about to give birth, we must ensure that we support the health care professionals in reaching out to those women who currently are not given the support from their partners or families that is vital if people are to bring children into the world who are hale and hearty. We will indeed work with health care professionals to ensure that their work is most effective in tackling some of these appalling figures.

To ask the Secretary of State for Health what steps he plans to take to increase the protection from abuse of people with learning disabilities in residential care. [7959]

We take the issue of abuse extremely seriously. We are determined to send a clear and unambiguous message that abuse in residential care will not be tolerated. The promulgation of good practice based on respect for the individual, and the importance of being able to identify and remedy actual or potential abuse, is a vital part of the Department's funding strategy, as is its work on developing a credible and comprehensive regulatory framework based on national regulatory care standards.

I congratulate my hon. Friend on ensuring that there is a public inquiry into the scandal in the long-care residential home on the borders of my constituency. Can he give me an assurance that the inquiry's report will be made public, in view of the fact that reports from certain similar inquiries were not made public because of insurance company requirements? When might the powers in the Police Act 1997 to check the criminal backgrounds of staff in residential care homes be brought into force, as that would make a huge difference in preventing the occurrence of another long-care tragedy?

We will certainly ensure that the conclusions of the report into the long-care scandal are made known and, more important, acted on. I am currently meeting the Minister of State, Home Office—my hon. Friend the Member for Cardiff, South and Penarth (Mr. Michael)—to determine when we will be able to move forward and ensure that local authorities can safeguard residents in homes by checking on the previous convictions, if any, of those who work there. That is a matter to which we give the highest priority.

The hon. Gentleman will know that the previous Government, and the then Opposition who are now the Government, have had common cause in ensuring that we root out any abusers in the care sector. However, will he take great care? A head teacher who came to see me the other day told me that nine out of 10 accusations of child abuse against individuals are found to be unfounded, particularly when they involve children with learning disabilities, and that they can cause enormous problems for and strain on the good staff whom we want to encourage. They are leaving the profession because they feel that they must constantly be on their guard and not be alone with children, because perhaps we have gone too far in what we have been trying to do.

We are anxious to avoid in any way reinforcing a culture of blame that can all too readily develop in this area. Equally, it is vital that all engaged in such work understand that toughness, transparency and accountability are the hallmarks of an effective regulatory system. That is something that the House will want to see put in place and that is something that we are determined to do.