What plans he has to improve access to NHS dentistry in the Yeovil constituency. [34700]

The Government are committed to improving access to NHS dentistry and are working closely with the profession to ensure that that happens. We have allocated £57 million to be spent on dental access centres and other personal dental services pilots over the current financial year. We will have 49 pilots running dental access centres from over 100 sites by the end of this financial year. Over £1.4 million of this funding has been invested to enable the opening of dental access centres throughout the Taunton and south Somerset area. Last February, a new centre was opened in the centre of Yeovil, and it has already provided NHS treatment to more than 1,200 local patients.

Does the Under-Secretary remember the Prime Minister's commitment at the Labour party conference in 1999 that everyone would have access to an NHS dentist by September 2001? Is she aware that none of my constituents has had access to such dentists for the past three years, and that new adult patients have not been able to see NHS dentists? What is she doing to put that right?

The hon. Gentleman is mistaken; his constituents have had access to NHS dentists. They may have had some difficulty with registration, but they certainly have had access to treatment. I understand that the hon. Gentleman personally opened the Yeovil dental access centre. He went there, he saw it and he opened it. The centre is treating 1,200 patients—1,200 people who have had access to NHS dentistry. Every week, 10,000 people are ringing up NHS Direct, 99 per cent. of whom are getting access to NHS dentists. Our pledge is being met; people can get access to NHS dentists up and down the country. Under the Conservatives, there was an onslaught on NHS dentistry. This Government are committed to improving access, in Yeovil and in the rest of the country.

What steps he is taking to secure improved provision of primary health care in south Derbyshire. [34701]

The Derbyshire Dales and South Derbyshire primary care trust will become operational on 1 April. Already, it is developing proposals to provide for the increasing population in that part of Derbyshire, to increase the number of GPs, to improve and extend practice premises and to increase access to NHS dentistry.

I thank my hon. Friend for that answer, which summarises the improvement in the prospects for primary health care within south Derbyshire. I should like to refer to the difficulties in accessing NHS dentistry within the area—which are now being addressed—and to the extreme pressure on GPs' lists in the area because of the rising population of what is a very attractive and popular place to live. Will my hon. Friend comment on the support that the Government will give to the primary care group and the new primary care trust, when it becomes operational, in any project that it proposes to improve the situation?

The primary care trust locally is trying to increase the capacity of primary care locally, including increasing the number of GPs. I am advised that the rate of increase in GP numbers in southern Derbyshire is faster than the average increase across the country as a whole. Clearly, we need to increase capacity in primary care.

Can the Under-Secretary give any comfort to my 18-year-old constituent from Parwich—which was covered by the South Derbyshire health authority—who was refused beta interferon treatment, but desperately needs that drug? Will the new arrangements give any comfort or hope to her?

The hon. Gentleman knows that beta interferon has been extensively looked at by the National Institute for Clinical Excellence. It is right that we take seriously its recommendations to the NHS across the country.

Will the Under-Secretary welcome the newly formed group of the mental health charity MIND in Swadlincote, south Derbyshire? Those involved will want to know whether she supports MIND's campaign "My Choice", to be launched tomorrow, which emphasises the need for a real choice of primary care treatments for those with mental health problems. What progress has been made in south Derbyshire in meeting the Government's mental health targets? In particular, what progress has been made in employing extra primary care staff to increase breaks for carers, employing new graduate primary care mental health workers and reducing suicide? We believe that in south Derbyshire—as in the rest of the country—the answer is that no progress has been made at all.

The hon. Gentleman will be aware that, for the first time ever, the Government have developed a national service framework for mental health. We are substantially increasing the capacity of primary care across the country. If the hon. Gentleman wants further increases in the capacity of primary care—including additional mental health workers in primary care, which the Government want arid have set out targets to achieve—he has to say where he will get the money from. The Government have said where we will get the money from. Perhaps the hon. Gentleman should ask his party's Front-Bench spokesperson Whether he agrees with the shadow Chancellor on whether taxes would rise under a Conservative Government to pay for that.

If he will make a statement on the availability of beta interferon to multiple sclerosis sufferers. [34702]

Following advice from the National Institute for Clinical Excellence, we have agreed a scheme with pharmaceutical companies for all multiple sclerosis patients meeting the criteria agreed by the Association of British Neurologists to receive beta interferon and glatiramer on the national health service. The scheme will begin on 6 May 2002. The cost will be about £50 million a year.

I am extremely grateful for that reply, which will certainly bring much relief to many of my constituents. Will my right hon. Friend confirm that those patients who currently have to pay privately for beta interferon, as well as those on health authority waiting lists, will benefit from the scheme? Does this mean that postcode prescribing—a legacy from the previous Government—has now gone?

I thank my hon. Friend for her support for the scheme. She is right: it will mark the end of postcode prescribing for beta interferon and glatiramer, and that is a hugely important step forward. I can confirm that, as we announced the details of the scheme to the national health service in a circular on 4 February, patients will be eligible for free prescriptions of beta interferon from that date.

Why has it taken more than two years to reach a decision on this issue? If the Secretary of State is able to overrule the National Institute for Clinical Excellence and ignore its advice, what is the point of having NICE?

It is rather sad that the hon. Lady could not welcome our announcement. The drug will now be available to NHS patients. It is true that NICE has been considering issues concerning beta interferon for some time, but it was a genuinely difficult decision for it to make. One of the benefits of the agreement is that it will now provide longer-term evidence of the benefits to MS patients of beta interferon and glatiramer—evidence that has not previously been available. It is an important step forward.

The Government deserve the congratulations of everyone in the House on the decision and on the ground-breaking agreement linking payment for the drugs with their efficacy. I see that my right hon. Friend is smiling. I think that the Government have done a great job here.

rose—

Answer.

Well, that's a tricky one. I was smiling because I was expecting a "but" halfway through my hon. Friend's point. I genuinely welcome his support and appreciate everything that he has said. There are some more general lessons to be learned, and I will ensure that I keep him informed of progress on not only this scheme but other relevant matters.

Will the Minister accept that it is not only beta interferon that can help MS sufferers, and that much pain relief is available from acupuncture, as practised at the George Eliot hospital in Warwickshire, for example? Will he also confirm that acupuncture is much cheaper and should be widely available in the health service?

I genuinely do not know whether acupuncture treatment is cheaper, over the course of a year or longer. On the hon. Gentleman's wider point about the availability of complementary medicine, as long as there is a strong evidence base for a treatment, we will consider making it available on the national health service.

What representations he has received on his proposals to involve the private sector in the management of NHS hospitals. [34703]

I have received a number of representations, and announced earlier this month the establishment of a register of interested organisations and individuals who come from a wide variety of backgrounds and are capable of turning around performance in the small minority of the worst-performing local health services.

Is not the theory that the private sector can successfully manage large acute NHS hospitals utterly perverse? Does my right hon. Friend understand why so many Labour Back Benchers are deeply unhappy with his proposal to introduce commercial hit squads as an advance guard for covert privatisation? Does he agree that the real wreckers of the NHS are not the failed administrators but the cynical promoters of the private finance initiative and management madness of the sort announced in the House six weeks ago?

No one on the Government Front Bench thinks that the private sector is a panacea for the problems in the NHS, but we intend to use it when it can bring expertise or resources to help improve services. My hon. Friend will be interested in the announcement that I made in early February about the first wave of so-called franchising. New management will be brought in to help turn around poor performance. I stress again that the people being brought in to help with the small minority of poorly performing trusts have some NHS experience. They have a track record of proven success in delivering improved NHS services.

Will the Secretary of State admit that he had no clinical outcome data to justify his labelling the hospitals as failing, and that the hospitals were not failing hospitals but scapegoat hospitals? On the day when the right hon. Gentleman announced the franchise plan, two hospitals that I visited—at Portsmouth, and Ashford and St. Peter's—were told that their performances merited two stars, even on the right hon. Gentleman's flawed performance indicators. Are not the hospitals involved facing problems of capacity owing to the scandal of bed blocking and nurse vacancies, which undermine capacity? Would it not be better for the Secretary of State to take expert advice to tackle the problems of capacity? If the private sector managers were from MFI and were able to bring beds with them they might be able to do some good—they will make no difference otherwise.

The hon. Gentleman's jokes are about as good as his policy—

Better.

The hon. Gentleman says they are better. I have two things to say about different performance in the NHS. First, every patient knows that there are some first-class hospitals delivering high-quality services. Often, they stand cheek by jowl with other hospitals that are not capable of delivering the same quality, even though they are dealing with precisely the same problems with the labour market, deprivation, health and capacity. The fundamental difference between such hospitals is management organisation, although culture and attitude sometimes play a part.

"Many of our policies are out of date, a legacy of past commitments, endlessly carried forward year after year rather than representing the sort of priorities which we might arrive at logically."

My right hon. Friend the Secretary of State will be aware that the Darent Valley hospital in my constituency is one of those being franchised out. The interim management led by Sue Jennings are already making an appreciable difference to the way in which the hospital is run, and improvements are noticeable all around. Will my right hon. Friend tell the House how the franchising system is running, and whether he believes that the system will finally bring the problems in the Dartford and Gravesham acute trust to an end? Will we be able to look forward to stability and improving standards in the future?

I am grateful for the support that my hon. Friend has given, in pretty difficult circumstances, to that hospital and to social services in the Dartford and Gravesham area. Some very real problems exist. They are partially problems of capacity and cash, but as my hon. Friend and other clinicians in the local community have recognised, they are also problems of management and organisation. If we can bring in some new blood from elsewhere in the NHS, and use that expertise for the benefit of patients in the area, that would be a sensible thing to do. I hope that the new management team that we will bring in before too long will help to turn around the performance of what has been a difficult hospital to manage. Patients there have not always had the services that they need. My hon. Friend knows as well as I do that good leadership in a hospital, just like good leadership in a school, is crucial to that hospital or school's success. I hope that by bringing in some new leadership, we can make a difference.

Is the Secretary of State aware that people in my constituency do not care whether managers are private sector or public sector managers so long as they are competent? We are relieved and grateful that his Minister overruled the decision of local managers to close the maternity and children's units at Hemel Hempstead general hospital and decided to try and keep them open. However, is not that decision a vote of no confidence, echoing the vote of no confidence in local management by all parties on St. Albans district council? Local managers have made it more difficult to keep those units alive by their decision to announce a closure, leading to the resignation of large numbers of staff and the biggest nurse shortages in any county in the country.

I shall certainly not stand here and condemn local management out of hand when I do not know the facts. I shall be very happy to look into the right hon. Gentleman's allegations. However, managing any public service, particularly the national health service, is not an easy job. It is pretty difficult. It would be helpful if Conservative Members got behind some of our people rather than always running them down.

Further to that question, will my right hon. Friend accept my congratulations on the tremendous work done by his colleague Lord Hunt for the Hemel Hempstead hospital and the special care baby unit in using the hospital to set up a pilot scheme looking at a national framework for neonatal services? Many of the local health service managers performed outstandingly well when it came to supporting Lord Hunt and arriving at that excellent decision.

I can only agree with my hon. Friend. It is often difficult when changes are proposed in local health services. I know that my hon. Friend has been concerned about the local situation; he has been to see me about it as well as my noble Friend Lord Hunt. I hope that the solution that we have come up with will be good for staff in the local hospitals as well as the patients who use the services.

What his policy is towards tackling bed blocking. [34704]

Our policy is to reduce bed blocking through additional investment and reforms to the way in which the national health service and social services work together.

I thank the Secretary of State for that reply. He will be aware that the bed blocking figures for my county are the sixth worst in the country. Given the right hon. Gentleman's personal commitment to private enterprise and the private sector, will he investigate Suffolk social services' abysmal record in encouraging the expansion of private sector residential home care places?

I will gladly look into the point about Suffolk county council. The hon. Gentleman is right that there is a particular problem in Suffolk with regard to care home or home capacity. I am aware of that. For that reason, the Government have made available additional resources above and beyond the resources made available to other comparable councils. Suffolk is receiving an extra £5 million in this financial year and the next financial year to stabilise the situation, presumably by first raising care home fees and then by investing in new capacity, presumably in the private voluntary sector as well as in the public sector, through intermediate care, rehabilitation services and all the other services that I hope the hon. Gentleman supports. That is the right thing to do first of all.

I welcome the £800,000 that the Government have given my constituency this financial year and the next to help with the problem of delayed discharges. That money is helping, but we still have far too many people waiting to be discharged from Princess Margaret hospital. I hope that my right hon. Friend welcomes last week's decision by Swindon borough councillors to restore proposed cuts in social services budgets, which would have reinforced the problem. I should be grateful if he would look at the situation. Social services have made it clear to me that we need more funds if we are to develop the specialist domiciliary services that are necessary to get more people out of hospital and into their homes, which is where they want to be.

As my hon. Friend knows—I visited her just a few months ago to talk about precisely such issues—I am aware of some of the problems in Swindon. In Swindon as elsewhere, we need to do three things. First, it is true that there is a problem with the level of funding received by many social services departments, not just for the care of the elderly but for the care of vulnerable children. Budgets are rising very fast, but resources have not always matched them. I am seized of that problem.

Given the Secretary of State's previous answer, does he accept that the time has come for a fundamental review of the funding of nursing care and the relationship between the two Departments? It is the NHS that is carrying the inevitable burden of an inadequate and inequitable system of nursing care funding that is producing perverse results such as that in west Kent. The Kent and Sussex hospital is making available extra beds and recovery wards just to hold the extra patients who cannot be released, but at the same time the number of nursing care beds in west Kent has declined by 17 per cent. in the past two years. Moreover, nursing care funding in Kent per elderly patient is a third of that received in other parts of the country such as London.

As I said to my hon. Friend the Member for South Swindon (Ms Drown) and to the hon. Member for Bury St. Edmunds, there is undoubtedly a capacity problem in the south—although the problem is not peculiar to the south—and we have to deal with it. Nursing home fees and fees paid by local authorities to care homes have not risen markedly for years. As a consequence, many owners of residential and nursing homes have decided to get out of the business. We must stabilise that situation, but we must do so through more investment. The issue for the hon. Member for Tunbridge Wells (Mr. Norman) and his party is whether they are prepared to match the resources that we have put into extra social services funding. The hon. Member for Woodspring (Dr. Fox) could stand at the Dispatch Box and agree with us that extra money is going into social services and that more is still needed.

Will the Secretary of State or one of his Ministers visit Portsmouth in the near future to see a good example of a working partnership between social services and the health authority, which has reduced deferred releases considerably? The money provided was very welcome, but a visit from the Secretary of State or a Minister would be a morale booster at a time of change.

You see—such visits are a morale booster. [Interruption.] The hon. Member for Woodspring is not convinced, but the Under-Secretary, my hon. Friend the Member for Salford (Ms Blears), who boosts morale wherever she goes, will visit that constituency. [HON. MEMBERS: "Hear, hear.] On that point, at least, the cross-party consensus on health is alive and well.

Does the Secretary of State accept that there is a clear relationship between the loss of care home beds, bed blocking in NHS hospitals and the increase in cancelled operations? Who is responsible for the current situation?

Of course there is a relationship between the capacity available outside and inside the hospital. That is absolutely true. I note with interest, however, figures from the premier market analysts, Laing and Buisson, on the care home market. Those figures confirm, first, that there has been an overall loss in care home capacity of approximately 19,000 places; and, secondly, that demand and supply are more or less in equilibrium in many parts of the country. That is not of course the case in all parts of the country, and we have made extra resources available where it is not so. If the hon. Gentleman and his party are so concerned, the question is whether they are prepared to put their money where their mouth is and match the record extra resources—

Order. The Minister should not ask the Opposition spokesman questions. Questions are put to the Minister for answer.

I am grateful to the Secretary of State for admitting the relationship, but I wonder whether it has come to him as a recent revelation. Why did the Government not do something about it earlier? More than two years ago, on Second Reading of the Care Standards Bill, we predicted exactly what would happen as a result of Government policy. We said that tens of thousands of care home beds would be lost with increased misery for elderly patients, more blocked beds, more cancelled operations and more patients waiting in casualty to be admitted to hospital. Will the Secretary of State apologise for his negligence and incompetence and for the fact that patients have to queue not just to get into hospital but to get out again?

It is interesting that the hon. Gentleman, who is so fixated about care home beds, did not say a word about NHS beds. There is a simple reason for that: when his party was in office, the number of beds in hospitals fell by 60,000. Under the Government, the figure is rising again.

That was a pretty disappointing answer, even by the Secretary of State's standards. Under Labour's stewardship, the number of NHS beds has fallen below the number of administrators for the first time in the history of the national health service, and that tells us all that we need to know about the Government's centralising tendencies. It is typical of the Secretary of State to hide behind a few figures. Under the present Government, we have seen the fiddling of waiting list figures and cancelled operation figures. We have seen the Government fixing accident and emergency times to make themselves look better. They have even taken wheels off trolleys so that they could call them beds and slapped themselves on the back for it. Does not all that simply show that the Government draw no distinction between truth and untruth, merely between convenience and inconvenience.

There is a fundamental question for our health and social services. We recognise that there is a big problem, which has been caused by decades of neglect and under-investment. The choice for the country is straightforward: are we prepared to invest more money—to put our money where our mouths are—to deal with the evident problems? We say that there is no such thing as a free lunch. If we want world-class health care, we have to invest and we have to pay for it. That is precisely what we are doing and what we are committed to doing. The issue facing the hon. Gentleman is whether he is prepared to match our spending, and the answer is a decisive no.

Does my right hon. Friend accept that things are not quite as simple as we tend to imagine. We tend to assume that people are either in hospital or in care homes. In fact, however, Nottingham Healthcare NHS trust tells me that the number of patients waiting to go into care homes has reduced greatly as a result of the Government's provision of money, but that there is a problem with intermediate beds for their transfer to acute care. Will my right hon. Friend address that problem as he funds the health service in coming years?

My hon. Friend makes an extremely important point: we face not only the problem that, when people are ready for discharge from hospital we are sometimes unable to discharge them, but the fact that many people need not end up in hospital at all. Provided that decent primary and community services are in place, we can offer more appropriate care, closer to home, for many elderly and disabled people.

If he will make a statement on trends in the uptake of the measles, mumps and rubella vaccine over the last 12 months. [34705]

The latest available evidence shows that the uptake of MMR at two years old stood at 84.2 per cent. in the summer and in the autumn of last year. The coverage by five years of age remained at more than 90 per cent., having fallen slightly compared with the previous quarters. Those figures were achieved despite extensive media coverage at the beginning of last year of unfounded claims of a link between MMR and autism.

We shall have to wait until the figures are published to see what the effects of the publicity of the past few weeks have been on the uptake. Will the Minister answer the question that she refused to answer during the debate held in Westminster Hall this morning? If a parent, for whatever reason—however irrational the Minister feels they are—refuses to give their child the MMR vaccine, should the child have three separate vaccinations or no vaccination at all?

The recommendation from the Joint Committee on Vaccination and Immunisation is clear. The Committee recommends the MMR jab as the safest way to immunise children against deadly diseases. The equivalent US committee has considered exactly the same issue within the past two weeks and has also concluded that it recommends only the MMR jab. It is not the job of the NHS to recommend something that is less safe and that would put more children's lives at risk. I really wish that Opposition Members would consider carefully the remarks that they make on this issue. It is disgraceful of them to play games with an issue that affects children's health and, ultimately, children's lives.

In the light of the fall in the rate of immunisation and given the outbreak of childhood diseases in the London area and other areas, does my hon. Friend welcome the campaign by Sense—the charity for deaf-blind victims of rubella—to inform parents of the relative risks of immunisation and non-immunisation?

I strongly welcome the campaign by Sense. One of the biggest risks in introducing separate jabs would be a dramatic fall-off in the coverage of rubella. Exposure to rubella among pregnant women can lead to serious cases of deafness and blindness in babies. That is not something that we want to return to in this country.

I have to point out that, once again, the Minister has not answered the question put by my hon. Friend the Member for Tatton (Mr. Osborne). It is a very important question. The Minister and I are in similar positions as mothers of small babies so she must surely appreciate the position of an individual parent. No matter how often the Minister says—with sincerity, I am sure—that MMR is the best route and no matter how much she believes that, she will not convince every parent in this country who has to take the risk to their own child into consideration. Will she not admit that it would be better to give three injections than none at all— [Interruption.]

Order.

I am sorry to hear that question—I really thought better of the hon. Member for Epping Forest (Mrs. Laing). The evidence and the advice from the medical experts, in this country and abroad, has been extremely clear: MMR is the safest way to immunise children, and introducing separate jabs would put more children at risk. It would lead to reduced coverage. Coverage would fall because children would be left unimmunised for longer between the jabs and more children would not complete the course of immunisation. Recent research from Chester shows that two thirds of the children who are currently given separate jabs do not complete the course. That is very serious. We listen to all the advice from the experts, but Opposition Members are expecting us to reject advice from huge numbers of independent medical organisations—to ignore their advice and to go for the politically easy option of introducing separate jabs. That would be politically easy but it would put children's health at risk and it would be morally wrong.

The Minister should know that 500 million MMR jabs have been administered worldwide since 1972, but not one scare has taken place in any country in the world, until that of the past year, caused by the political opportunism of the Conservative party. For the sake of allaying young parents' fears and for the sake of sanity and the health of young people in this country in the future, will the Minister and the Department engage in direct mailing or become involved in ensuring that GPs' surgeries inform parents of the weight of medical and nursing opinion behind the MMR jab?

My hon. Friend is right. The overwhelming evidence from and consensus in 90 countries across the world support the MMR jab, not separate jabs. That is exactly why the assistant surgeon general in the United States, the head of the vaccine programme of the Pan American Health Organisation, the regional adviser for communicable diseases of the World Health Organisation, the chairwoman of the Australian National Immunisation Committee and the chairman of the American Academy of Paediatrics have all recently contacted us to urge us not to introduce separate jabs and to stick with MMR.

How many cancelled operations there were in each of the last two years. [34706]

In 2000–01, 77,818 operations were cancelled on the day by the hospital for non-medical reasons. During 1999–2000, 60,242 operations were cancelled.

Given that significant national increase and the fact that, in Hertfordshire, the number of cancelled operations has more than doubled in the five years since 1997, will the Minister explain why the link between bed blocking and the increase in cancelled operations matters? What will she do to reduce both those factors?

A whole range of issues is likely to determine the number of cancelled operations. The Government are taking action through the Modernisation Agency and an £8.5 million project to ensure that good management and reform is in place to cut the number of cancelled operations. As my right hon. Friend the Secretary of State has already said, we are taking significant action and investing significant amounts of money to ensure that we tackle the problem of delayed discharge and its effect not only on the health service, but especially on the individuals whom it affects. We are also increasing capacity in the health service. Although we have not made much progress on that issue, we need to return to the fact that the Government are putting in place the reform and investment necessary to make the difference. Would Opposition Members support that investment?

I welcome the Minister's statement about the action that the Government are taking to reduce the number of cancelled operations. However, to put the issue in context, will she confirm that, since the Labour Government came to power, the number of operations completed by the NHS has increased by more than 500,000, and that the answer is not to return to the Conservative approach of carrying out fewer operations, but to continue to put in additional resources, so that more people are treated by the NHS under a Labour Government?

My hon. Friend is right. Not only are we performing more operations in the NHS, but we are achieving better outcomes in the NHS. The NHS and those people who work in it deserve congratulations on that. Of course, that is happening because the Government are increasing the capacity of the NHS to do so. For example, we have achieved our NHS plan pledge for 20,000 more nurses by 2004 two years early. Opposition Members described that pledge as preposterous. It is not preposterous; it shows that the Government are delivering for the NHS and its patients.

As one of the most significant contributing factors to Portsmouth Hospitals NHS trust's failing was the high number of cancelled operations, will the Minister give an assurance that finance will play no part in the cancellation of further operations in our hospitals? Will she also consider whether the new private finance initiative franchising scheme for Portsmouth will have to carry forward the £3 million deficit? If it does have to do so, it will lead to even more operations having to be cancelled.

I am not surprised that Liberal Democrats, following the lead of their health spokesman, should argue for more resources to go into the health service. We have no objection to that. This Government, in two spending reviews, have increased the amount of money going into the national health service by more than a third. However, that must be matched by the sort of reform that is also necessary to ensure that we reduce levels of cancelled operations—sharing best practice, ensuring that the Modernisation Agency brings about improvements and investing in diagnostic and treatment centres to split emergency and elective care. Money itself is not enough—it is crucial, but so is the reform with which this Government are accompanying it.

Will the Minister confirm that the 77,818 operations cancelled last year for non-medical reasons represented not only a 50 per cent. increase under her Government but an increasing trend over the last year—up by 29 per cent.—and an increasing proportion of total operations? Even more worryingly, the number of patients not readmitted for their operation within a month has more than doubled. Although her response to the problem—spending £8.5 billion on appointing a gaggle of cancellation tsars—will no doubt have many patients dancing on their trolleys, will she tell our constituents, in layman's terms, her definition of non-medical cancellations? Furthermore, will she explain why, in her national health service, there are such wide variations in cancellation rates between hospitals, ranging from 0.1 per cent. to 18 per cent?

Levels of cancelled operations in the national health service are too high. That is why this Government are reforming the service and ensuring that efficient management and systems are in place. Most important, we are increasing the capacity in the national health service. There were more beds last year for the first time in 30 years, more staff and an increase of 5.7 per cent. in the number of consultants working in the national health service. We are increasing capacity and investment. Will the hon. Gentleman support and reinforce that?

If he will make a statement on the number of dentists working in the NHS. [34707]

A total of 20,480 dentists were working across all dental services in England in September 1997. The number of dentists working in September 2001 was 22,440. That is an increase of 1,960.

I thank my right hon. Friend for that answer and welcome the increase in the number of NHS dentists. Does he agree that in market towns, such as Whitby, where there is great difficulty in gaining access to NHS dentists, people have to travel to larger centres? Will he say what the primary care trust can be expected to do to make it easier for people in rural locations to have access to NHS dentists?

I agree with my hon. Friend that people in some rural areas clearly experience problems in accessing NHS dentistry. That is true in my constituency. I am sure that he will welcome the decision of the local health authority to establish one of the new dental access centres in his constituency on two sites—one in Scarborough, with which I am sure he is familiar, and one in Whitby, too. Next year, when the service begins to operate with full efficiency, it is estimated that it will be able to treat about 3,500 patients in his area. That is an important step forward.

The experience of the hon. Member for Scarborough and Whitby (Lawrie Quinn) matches mine in Chippenham, a town of 35,000 people in which not one national health service dentist practises today. Is the Minister aware of the British Dental Association's commentary on the so-called dental strategy? It says:

"There is nothing very new in the strategy. What we've been given is ministerial double-speak…We are heading for an unmanned toothache service."

I have a great deal of respect for the hon. Gentleman, but he is speaking a load of old cobblers. He might like to look at some of the statistics on NHS dentistry because he will probably be struck, as I was, by the fact that since 1997 the total volume of NHS dental treatment has increased by 1.8 million. That compares strongly with the period between 1992 and 1997, when the number of NHS treatments for dentistry declined. Of course there is a problem. It would be stupid to pretend otherwise and we are taking action to deal with that. The dental strategy is not a waste of time. It is increasing NHS access to dental treatment and I am surprised that the hon. Gentleman cannot find it within him to welcome any of the progress that is being made.

Although I welcome the increased number of dentists who work in the NHS in England, will my right hon. Friend undertake to hold discussions as soon as possible with the Health Minister in the National Assembly for Wales to compare the success in England with the success stories in Wales?

I am grateful to my hon. Friend for that question. She is aware that such matters are the responsibility of the National Assembly for Wales. However, we keep in regular contact with Jane Hutt, the Health Minister in the Assembly, and we share similar objectives to increase access to NHS dentistry in all parts of the United Kingdom.

If he will make a statement on waiting times in accident and emergency units. [34708]

The NHS plans set a target to reduce waiting times in accident and emergency departments to a maximum of four hours from arrival to admission, transfer or discharge by 2004. The NHS is on track to meet that target with 77 per cent. of all A and E attenders currently spending four hours or less in A and E. In nearly a third of trusts, at least 90 per cent. of people attending A and E are discharged or admitted within four hours. The Government launched the reforming emergency care strategy last October, supported by investment of £118 million. That is helping hospitals around the country to tackle waiting times in A and E departments and to meet the NHS plan target.

I grateful to the Minister for that upbeat reply. I am afraid that the community health councils, which her Government have pledged to abolished, do not agree with her, however, as they said in their report, "Nationwide Casualty Watch" recently. At the Royal United hospital in Bath and Salisbury district hospital, 10 per cent. of my constituents admitted through the casualty department have to wait for four hours or longer on a trolley. What is she going to do about that? Will she condemn the practice of keeping acutely ill patients waiting in ambulances outside casualty departments for long periods of time?

I am pleased to tell the hon. Gentleman that the Government are taking a series of actions to address the admittedly serious problems in his local hospital. An intervention team was established on 7 January this year. It comprises top-class consultants and physicians who have gone into the hospital to work side by side with the clinicians to help them to change their practices, to improve the length of time that people wait in A and E and to ensure that delayed discharges are treated in a much better fashion.

Order. The Chamber is far too noisy.

May I thank the Minister for the extra investment in the A and E facilities at the Queen's medical centre in my constituency? I hope that she had a chance to see the excellent fly-on-the-wall documentary produced by Channel 4, "The Trust", which illustrated the enormous pressure under which the A and E department is having to work. I am sure that she recognises that some causes of that pressure are not within our control, but will she act on two points that arose from the documentary? First, will she support the QMC's initiative to take a zero tolerance approach towards violence by patients against A and E staff? Secondly, will she hold serious discussion with primary care trusts about the withdrawal of funding for community-based services relating to drugs, mental health and alcohol problems, which result in a disproportionate—

Order. We will now let the Minister reply.

I am delighted that my hon. Friend is pleased about the modernisation that has taken place in his local A and E department. Some 180 A and E departments throughout the country have been improved as a result of Government investment. I am also glad to reassure him that we have a policy of zero tolerance of violence against every person working in the NHS, and those of us who have visited A and E departments on a Friday and Saturday night will have seen the entirely unacceptable stress under which staff operate.

It is not only accident and emergency waiting times that concern us; between 1997 and 2001 the number of people in Wales waiting for treatment for six months or more increased by an enormous 1,000 per cent. In the past, the Secretary of State has told us with some glee that he does not do Wales, but does he not accept that he has some responsibility for that scandal?

Obviously, those are devolved matters, but it is not a question of us not doing Wales at all. We are delighted to be able to work with our colleagues in the devolved Administrations to make sure that everybody has the chance to access high quality services. I am sure that the hon. Gentleman knows that our NHS services are operating under tremendous pressure; A and E departments see 15 million patients every year, which is 30,000 patients every day, and in the vast majority of cases they are providing top-class, first-rate services. Clearly, there is increased pressure, but the Government are tackling that with increased investment in every part of the NHS, including primary care, secondary care and accident and emergency. That is this Government's record, and I wonder whether any Opposition Members would be prepared to match that investment to make sure that we can provide high-quality services for people in every part of the country.

I am sure that my hon. Friend is aware of the enormous pressures on Leicester royal infirmary. We welcome the extra investment that will improve its capacity. Is my hon. Friend aware of the fantastic achievement of walk-in centres in reducing the number of admissions to places such as the royal infirmary? Will she ensure that continued funding for such centres, particularly the excellent one in Loughborough, is part of the NHS budget from the centre, rather than the burden being placed on local primary care trusts?

My hon. Friend makes a characteristically intelligent and analytical remark about the role of NHS walk-in centres. He is absolutely right that such centres, of which there are now 42 throughout the country, with another one set to open this summer, are playing a significant role in reducing pressure on A and E departments because they are able to see many patients with minor illnesses. It is important that we evaluate walk-in centres, which are still pilot projects, before extending the funding nationally. It is vital that we ensure that walk-in centres, minor injury units, NHS Direct and out of hours services provide high-quality services.

What recent discussions he has had with representatives of health care professionals on the impact of Government targets on clinical decision making. [34709]

Ministers in the Department of Health meet regularly with representatives of health care professionals to discuss all aspects of the Government's strategy for investment and reform in the NHS.

Is the Minister satisfied that in the north-west cancer patients are being diverted from treatment simply to meet the Government's two-week waiting target when treatment does not affect survival? Would it not be more satisfactory to move to average waiting times when setting those targets, as the Liberal Democrats advocate?

To be honest, I am probably not alone in not quite knowing what the Liberal Democrats are saying about access to treatment. As I understand it, they want waiting times to come down, but they cannot say by how much or even give a time when patients should be treated. The majority of the hon. Gentleman's constituents, and other Members of this place, want patients to be treated at the earliest opportunity, especially if there is a diagnosis of suspected cancer. It is right that we have set targets, which patients and the public support. The hon. Gentleman may be interested to note that the death rates for two of the country's major killers, cancer and heart disease, are coming down, and that more than 90 per cent. of cancer patients are now being seen within two weeks of urgent GP referral. That is progress and not, as he would like to characterise it, a step back.