What plans he has to devolve resources and decision making to front-line staff. [109800]

Power and resources are being devolved to the NHS front line. The old health authorities and regional offices have gone, and new primary care trusts are now in place, which control three quarters of the total NHS budget so that local services can be shaped better to meet the needs of local communities.

Does my right hon. Friend accept that to create a world-class health service we need both investment and reform? Investment is running at record levels. Is it not now time to try to influence, involve and empower all members of the NHS team in taking forward our health service?

I very much agree with my hon. Friend. Clearly, record resources are now going into the national health service, and we have the fastest-growing health service of any major country in Europe, after many decades, including under the previous Government, during which investment was cut back rather than increased. As my hon. Friend rightly says, we need reforms in the system as well as resources, and now is not the time to take our foot off the accelerator of reform. With the extra resources going in, we need to see as much pace on reform. In particular, we need to ensure that we get the balance right in relation to standards being set nationally to guarantee equity in the system, about which we have done a lot over recent years, with national standards and national systems of inspection. Ultimately, however, neither I nor this place delivers health care: it is delivered out there in local communities by local members of staff. Those people, both in the community and among members of staff, should be empowered.

But does the Secretary of State acknowledge that, two weeks ago, Dr. Ian Bogle of the British Medical Association said that new evidence showed that 80 per cent. of doctors had not seen any improvement as a result of the increased NHS spending, and that excessive national targets were preventing additional money from reaching the front line of health care? Does he agree that it is not surprising that the general public have lost confidence that the Labour Government are capable of delivering a first-class NHS?

Of course, Dr. Bogle is a member of the NHS modernisation board, which produced its recent annual report. I do not know whether the hon. Lady has had an opportunity to look at that annual report, but among other things it said that the money was getting through to the front line. Indeed, it went on to say that the NHS was turning the corner. Clearly, there are problems that are still outstanding, but the only way of addressing them is to continue reforms in the national health service and continue putting resources into it, and not to do what the hon. Lady and her party propose, which is to cut NHS budgets by 20 per cent.

Is not my right hon. Friend the Secretary of State anxious that his proposals for foundation hospitals may reduce the improvements that primary care trusts are bringing in representing local communities and that "agenda for change" has the potential to bring in terms of NHS staff pay?

No, I am not anxious about that, for a number of reasons. First, for the very first time under the NHS foundation trust proposals—I think my hon. Friend has seen a copy of the Bill that has now been published—primary care trusts will be represented on the board of governors of NHS foundation trusts, thereby strengthening the link between primary and secondary care, which I know is what she is keen to see, as I am too. I think she is further aware that, in addition to the safeguards already in the Bill, I have given a guarantee that the "agenda for change" pay system, which we have negotiated with the NHS trade unions—to which I am pleased to say both the Royal College of Nursing and the Royal College of Midwives, have given the go-ahead in ballots by votes of 80 per cent. and 90 per cent.—will apply across every part of the national health service, including in NHS foundation trusts.

Does the Secretary of State agree that what most people want to see in terms of resources in the front line is a full range of complementary and alternative therapies? May I take this rare opportunity to congratulate him on his announcement over Easter of £1 million to go into research and development in relation to complementary therapies? Can he explain why that news came out over Easter, as the bank holiday weekend is traditionally used to put out bad news? Is it because he is acutely embarrassed that it has taken the Government so long to see the light, and the need for a greater use of complementary and alternative therapies in the health service?

I know that the hon. Gentleman has a certain regard for complementary therapies. I do not think that they are the talk of the pubs and the clubs in my constituency, but they may well be in his. One of the reasons why we gave the go-ahead for the additional £1 million was in the very real hope that he would not raise this issue at every single Question Time. Alas, my hopes have been dashed.

The NHS is refusing to spend £30,000 for a bone marrow transplant programme for my constituent, Diana Fildes, who has Crohn's disease. Will the devolving of resources start to help people such as Diana in the future? Is it not a mammoth task for family, friends and former pupils to have to seek to raise £30,000 in funding for private treatment? What have we got a health service for if not for that?

I am not aware of the case that my hon. Friend has raised but, if he passes me details, I will be more than happy to look into it and to come back to him.

What assessment he has made of the performance of the Worcestershire Royal hospital. [109801]

The Worcestershire Royal hospital, as part of the Worcestershire Acute Hospitals NHS trust, was awarded two stars in the latest NHS performance ratings, received a positive Commission for Health Improvement clinical governance report recently, and achieved all its waiting list targets for the end of March 2003. I would like to congratulate all the staff at the hospital on their commitment and dedication to the needs of NHS patients.

I thank my right hon. Friend for that reply. He may have noticed that the Worcestershire Royal hospital was shortlisted as one of the top six hospitals in the country by a recent survey in The Sunday Times. Would he add his congratulations on that achievement and does he share my dismay that one Member of the House commented that The Sunday Times survey must be worthless because the Worcestershire Royal hospital did well in it? Does he agree that such comments do nothing for staff morale and nothing for the recruitment of key medical personnel, but have everything to do with undermining faith in our national health service?

The Worcestershire Royal is an excellent hospital that is doing a very good job in improving the range of services available for local people. I would certainly like to emphasise the achievements that have been made in the hospital. I also think it is incumbent on all right hon. and hon. Members to support their local NHS. When that does not happen, it is a cause of great disappointment, not least to staff locally.

Notwithstanding the very real achievements that doctors and nurses have made at the hospital, I am sure that the Minister would wish to say that there are some very real problems at the trust. The district auditor's report identified it as the most expensive in the west midlands, and there are acute car-parking problems and patients cannot make appointments. [HON. MEMBERS: "Oh, dear."] I am sorry that Labour Members feel that patients not being able to make appointments is a matter of no concern. There are also serious waits on trolleys after accidents, and a whole range of problems. Will the Minister tell the House by when the trust will have to clear its accumulated deficit, because the great pressure it is under to meet financial deadlines imposed by the Government is inhibiting its ability to deal with its remaining problems? When will it have to clear its deficit?

I think the hon. Gentleman is right to draw attention to the fact that there are continuing issues. He has referred to the problems of car parking at the hospital, which I understand the local trust is addressing.

The Minister will be aware that the wait for an MRI scan in Worcester is more than 12 months and that the mobile MRI scanner at Kidderminster, where the waits are shorter, is about to be withdrawn. Will he ensure that the static MRI scanners to be installed elsewhere in the county— particularly in the diagnostic and treatment centre at Kidderminster—are not delayed by the county's financial deficit?

I am not familiar with that particular problem, but I will certainly look into it.

If he will make a statement on services provided to patients with dual diagnosis of mental health and addiction problems. [109802]

As part of the work to modernise mental health services, the "Dual Diagnosis Good Practice Guide" was issued last year. Following the publication of the national service framework for mental health, we have embarked on a radical modernisation of services to improve access to effective treatment and care, to reduce unfair variation, to raise standards and to provide quicker and more convenient services to all people with mental health problems including those with a dual diagnosis of addiction.

Does the Minister agree that such patients have a particular need for supported accommodation and ongoing social services support? However, because they have the greatest problems, they are often the ones who fall through the safety net. Will she consider increasing resources for programmes such as assertive outreach and ensuring that patients with dual diagnosis problems are taken into account?

My hon. Friend raises an important point. Despite the considerable extra investment in our mental health services and staffing increases, we nevertheless need to examine new ways in which to organise the services. I strongly agree with her, as we spelt out in the national service framework, that assertive outreach teams are particularly able to get to some of the people who have fallen out of touch with services in the past, perhaps because they had additional problems such as drug or alcohol addiction, which had knock-on bad effects for their health and for communities as a whole. That is why I am pleased that extra investment for assertive outreach teams is being considered in Tower Hamlets. The existing investment in our mental health system means that 191 additional assertive outreach teams are operating throughout the country to bring people who had lost touch with mental health services back in touch.

A lesson from the first Gulf conflict was that many returning service personnel were susceptible to mental health problems, which were often combined with addiction problems, especially alcohol addiction. Given that fewer than 20 per cent. of the Government's required crisis resolution teams are in place, how can the Minister justify her claim on 6 March that there is

"operational flexibility within the system"

No, it is not. As I have spelt out in response to the hon. Gentleman's questions, it is clearly the business of mental health services to deal with any mental health problems that might arise when people return from active service, as is the case with the wide variety of other needs that they address. We have made it clear that people with a dual diagnosis of mental health problems and drug or alcohol addiction are mainstream business for mental health services.

Fewer than 3 per cent. of people with an addiction to heroin are receiving medical treatment. How long will we allow a presumption in favour of dual diagnosis to be a smokescreen for stopping proper medical treatment for such people?

The dual diagnosis guidance that we issued made it clear that treatment for the significant number of people who have both a serious mental illness and a drug addiction is part of the mainstream business of mental health services. We need to do work, especially to ensure that we reduce waiting times for people who need specialist treatment services, which also have specialist mental health services alongside. We are making progress on extra capacity and new ways in which to deliver those services. I agree with my hon. Friend that it is unacceptable if people do not receive suitable treatment. We will ensure that we address the problems through the additional investment and new forms of treatment that we are implementing. However, only the investment that we are undertaking will ensure that that happens.

If he will make a statement on needlestick injuries. [109803]

The Government recognise that the number of needlestick injuries occurring in the NHS is still too high. The Minister of State, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), recently met the all-party parliamentary group on occupational safety and health and agreed that new guidance will be issued to the service in the autumn.

Given that the annual cost of treating NHS workers who have suffered needlestick injuries is estimated to be in the order of £300 million and that the estimated saving from acquiring safer needles could be about £140 million, and given that even when needlestick injuries are subsequently shown not to have caused serious physical harm they almost always cause immense emotional trauma, will my hon. Friend join me in supporting the objectives of the Needle Stick Injury Bill promoted by my hon. Friend the Member for Crawley (Laura Moffatt)?

My hon. Friend is right that needlestick injuries are a serious issue in the NHS. They cause immense distress to staff, especially when they are waiting for the test results to discover whether they have been infected. That is why we support the work of the safer needles network and why the Department works with trade unions and staff on that issue. Safer devices have a role to play. Equally important, however, is excellent training for staff on how to use those devices, and refresher training has been proven to reduce the number of incidents dramatically. On the Bill, health and safety legislation requires incidents to be reported. We want those regulations to be used as much as possible to ensure that we have the fullest possible information so that we can support staff in those difficult conditions.

If he will review the level of provision of NHS dentistry in South Devon. [109804]

We are committed to rebuilding and restoring NHS dentistry to continue to improve the oral health of the nation. Alongside the proposals in the Health and Social Care (Community Health and Standards) Bill, 26 field sites covering 50 different locations are being set up to test different ways of providing NHS dentistry. One of the largest of these field sites covers the south-west peninsula and builds on the successful personal dental services pilot in Cornwall.

In spite of that answer, is the Minister aware that no dentist in Totnes is taking newly registered patients and that it takes a whole day on public transport to go to and to be treated by an NHS dentist, which is not possible for many people? Would it help if we ring-fenced the dentistry part of the primary care trust budget to relocate dentists into south Devon?

I know that there are problems of access in south Devon because of rurality. If one dentist leaves a town or village, it can mean that people cannot get registered. That is why we are putting in dental support teams across the country where there are still access problems and the hon. Gentleman's area will of course be considered for that. I hope that he will support the Bill that I mentioned to ensure that primary care trusts can commission dental services in the way that he suggests.

What plans he has to increase the number of care workers being trained in Kent. [109805]

Training of care workers supports and protects vulnerable people and helps to recruit and retain important staff. That is why we are providing more than £2 million of additional money to councils in Kent this year specifically for training and work-force development, as well as funding through Topss England, formerly the National Training Organisation for Social Care, to help the staff of all social care employers in Kent to undertake training and qualifications.

I welcome that extra investment for Kent. I know that my hon. Friend takes a close interest in all Kentish matters and she is welcome in the garden of England any time.

My hon. Friend is right. I enjoyed our meeting with the Kent community care association, which, as an employer in the voluntary, independent arid private sector, has clearly showed its commitment to training staff. However, it has also recognised that in the past it has sometimes been difficult, even when additional resources have gone to local authorities, for a significant number of employers in the independent sector to get access to those funds. That is why we will be putting a condition on the additional money that we will make available over the next three years requiring 50 per cent. of it to be spent in the independent sector.

Does the Minister accept that one of the problems facing trainees and care workers in Kent and elsewhere is the fiasco over the past 12 months with the Criminal Records Bureau? Does she accept that notwithstanding the two U-turns that the Government have had to make there are still considerable problems? Does she not feel that it was unwise not to accept the advice of the Opposition prior to the implementation of checks, to the effect that the bureau was over-ambitious in seeking to check everyone from the outset? What is happening to the backlog, as opposed to current applicants requiring a check? The evidence suggests that there is a considerable problem with that backlog despite the fact that current applicants are being dealt with quicker.

I think that the hon. Gentleman arid I will have a chance to pursue that at greater length later this afternoon, but I can offer him reassurance now. I share his concern about the performance of the Criminal Records Bureau, which is why my right hon. Friend the Home Secretary instituted a significant review of its operations and why we, along with other colleagues in government announced last November a delay in implementing some of the bureau's checks for certain groups of workers. We wanted to make sure that we could get the bureau back into the shape necessary to provide protection for vulnerable people—a role in which I believe it plays an important part.

If he will make a statement on the number of finished consultant episodes in the NHS in England in each of the last four years. [109806]

The number of finished consultant episodes in the national health service in England increased from 11.6 million in 1997–98 to 12.4 million in 2001–02. For 2002–03, hospital in-patient activity is expected to increase by a further 4.5 per cent, and outpatient activity by a further 2.5 per cent.

I thank the Minister for his answer, although I note that he did not give a figure for finished consultant episodes for the coming year. The Chancellor of the Exchequer and the Secretary of State have made it clear—[Interruption.] The Minister gave a figure for elective admissions, where there has been a 4.5 per cent. increase, but did not give a figure for finished consultant episodes. The Secretary of State and the Chancellor have made it clear that increased reform in the NHS must accompany increased spending, yet we have all seen in our constituency surgeries that spending does not appear to result in our constituents having fewer problems with the NHS. If anything, the situation is getting worse. Can the Minister tell us when he expects increased spending in the NHS to be matched by increased activity?

I am sorry, but the hon. Gentleman clearly does not understand what he is talking about. The figures that I quoted to him are for finished consultant episodes in the years for which the information is available. I cannot give a figure for the number of finished consultant episodes for this year, because this year has not ended yet. The information is historical, not prospective. The hon. Gentleman asked when the additional investment in the national health service would produce additional activity. It is already doing so. For example, it has helped us to recruit an extra 5,500 consultants for the NHS, almost 50,000 additional doctors and almost 8,500 additional allied health professional therapists. The NHS is busier than it has ever been before. If the hon. Gentleman wanted any confirmation of that, he would just need to ask his local NHS staff, who would tell him that the NHS has never been busier.

Is my right hon. Friend aware that the number of finished consultant episodes—that is, the number of patients treated—at York district hospital has increased over the past four years by 11 per cent., and that in some specialties—in general medicine, for instance—the number of finished consultant episodes has increased by 34 per cent.? Will my right hon. Friend congratulate the York health trust on its achievement? Does he agree that if the Conservative party were ever in a position to implement its cuts—

Order. That is not for the Minister to worry about.

I join my hon. Friend in warmly congratulating the staff in York on the excellent job that they are doing. He, like me, would probably have concluded from these and earlier exchanges that there are some people who want to talk down the national health service, as a cloak for a broader attempt to undermine the NHS and replace it with private provision and top-up vouchers—something that the Labour Government will never do.

Given that we need more operations than we have at present to clear the backlog, can the Minister explain why the Government have decided to spend so much extra on administration, rather than on front-line care, so that there are now more administrators than beds? Is that not a strange choice?

That is a hackneyed and well-worn contribution, and is simply not true. The right hon. Gentleman reaches that conclusion only by counting cooks, cleaners and porters as managers and administrators. Anyone with common sense—I am afraid that that excludes the right hon. Gentleman—would know what a load of nonsense that equation was.

If he will make a statement on progress towards the target of no patient's waiting over 48 hours for a GP appointment. [109807]

The most recent data from February this year show that nationally some 86 per cent. of patients are now able to be offered a GP appointment within two working days. In 1997 the comparable figure was only 51 per cent.

I declare a non-registrable interest, in that my wife is a GP.

I agree with the hon. Gentleman in one respect—that we need more GPs in the national health service, and we are recruiting more. Since 1997 there are 1,200 more GPs working in the NHS. That is a positive development, which I am sure he would welcome, as would his wife. There are local recruitment problems. That is obviously the case, as all right hon. and hon. Members know from their constituencies. I am advised that in the primary care trust in the area that the hon. Gentleman represents there are now 11 more GPs working than in 1997. That is progress, but I agree that there is more to do. I do not, however, agree that we will not meet the target unless there are significantly more GPs. The work of the primary care collaborative has shown—I do not know whether there are practices in the hon. Gentleman's primary care trust that have taken part in the work of the collaborative—that by looking critically at how we structure appointments in primary care, it is possible to provide patients with better access. One thing that I have learned, both as a Minister and as a Member of Parliament, is that access to the services of a GP and a hospital is the public's top priority. That is what we are trying to meet, and that is what the targets are designed to help bring about.

Does the Minister accept that one of the factors in obtaining an appointment with a GP is coping with rising population trends in areas such as Swadlincote in my constituency? Will he therefore advise NHS management to ensure that we proceed as rapidly as possible with the LIFT—local improvement finance trust—project to rebuild Swadlincote's clinic to accommodate a new GP practice, which would greatly improve access to GP care from that town?

Yes; I agree with what my hon. Friend says. The NHS LIFT programme is a very welcome boost to investment in primary care ensuring that almost £1 billion of investment will go into the infrastructure of the NHS primary care estate. That is long overdue, and it is an essential complement to the work that we are doing to improve services and secondary care. I agree strongly with what he said.

As ever, the Minister's response tells only part of the story. When the Government instructed GPs not to keep patients waiting more than 48 hours, the response from many practices was to stop taking appointments more than 48 hours in advance all together, even if patients wanted them. Is not this merely another target that is being achieved only by moving the goalposts?

No; that is simply not true—it is not the case. The Government have issued no such instruction. If the hon. Gentleman's case rests on some instruction that we have issued, I am afraid that he will be disappointed. The Department of Health has issued no such instruction.

What recent representations he has received in relation to his plans for foundation hospitals; and if he will make a statement. [109808]

Representations have been received from a number of organisations and individuals about NHS foundation trusts. The Health and Social Care (Community Health and Standards) Bill, which was published on 13 March, sets out our legislative proposals for NHS foundation trusts.

The Government's commitment to a primary care-led NHS with high national standards and free from excessive bureaucracy is most welcome, but does not the foundation hospital ideology run directly counter to those values? Is not the Secretary of State engineering a US-style system of health care rooted in market morality and private provision that is not old values in a new setting, but a mistake of fundamental historic importance—a Trojan horse for Sedgefield privatisers and Darlington money changers, perhaps? [Interruption.]

I got the impression that my hon. Friend was not too enamoured of the proposals. There is a fundamental difference, however, between the US system and the English and British system, and as long as this Government are in power, that will certainly remain the case. Our system is free at the point of use and it treats people according to their need, not their ability to pay. Anybody who wants to advocate the American system, as some Opposition Members do, needs only to look across the Atlantic to see what happens when profit is put before the interests of patients. Some 40 million Americans have no health insurance policy whatever. More charges for patients are not a Labour policy, but a Tory one. That is not what this Labour Government advocate or what NHS foundation trusts are about.

In his Budget statement, the Chancellor said that we needed to recognise local and regional conditions in pay and that the remits for the pay review bodies would have a stronger local and regional dimension. How will the Chancellor's regional pay operate in the NHS and what additional freedoms will foundation hospitals have in setting pay and conditions?

It is right, as my right hon. Friend the Chancellor of the Exchequer said, that we need to recognise that there are different labour market conditions in different parts of the country. That is already recognised and, incidentally, it has been recognised for many years, if not decades, in the NHS pay system. For example, we have a London allowance, although we do not have a Darlington allowance or, for that matter, for the information of my hon. Friend the Member for North-West Leicestershire (David Taylor), a Sedgefield allowance.

We naturally welcome it when the Government are converted to the importance of market solutions to the problems in the public services. We now have the Chancellor's regional and local pay, the Prime Minister talking about co-payment, PFI elevated to a neo-religious movement, PCTs purchasing from private providers, including private hospitals, and opt-out foundation hospitals on the way—all aimed at greater diversity in provision. The Secretary of State may recall telling the House that

"by and large, we thankfully have one monopoly provider and that is the NHS. As long as a Labour Government are in power, that will remain the position."—[Official Report, 26 June 2001; Vol. 370, c. 500.]

What characterises markets—as I am sure the hon. Gentleman understands, given that he is, to use his own description, an unreconstructed Thatcherite free-marketeer—is the ability to charge, which is precisely what he is advocating. It is not what this Labour party or this Labour Government are advocating. [Interruption.] The hon. Gentleman says that that is not what he is advocating. I believe that just before Easter he produced his own patient passport proposals, which clearly set out his determination to develop what he called a "self-pay market" in which more and more people would pay for their treatments in hospitals and in other settings. That is a Conservative policy, not a Labour policy; it is what he wants to do, not what this Labour Government will do.

Is my right hon. Friend aware that the greater autonomy, independence and accountability at the local level that lies at the heart of his proposals for foundation hospitals is widely accepted by Members on these Benches? Is he also aware that we welcome greater local accountability and the extra £40 billion that he has achieved from the Treasury? Does he agree that we shall need that local accountability in order wisely to spend that money over the next few years, and that it is about as much money as can be wisely and effectively spent by hospitals, be they foundation or otherwise? Will he therefore consider introducing the extra borrowing requirements that form part of the present proposals as reserve powers that could be activated later, in better circumstances, by an affirmative vote of the House? That would make it a lot more acceptable all round.

I am grateful to my hon. Friend for his support for the principles of earned autonomy and greater freedom for NHS hospitals: that must be the right way forward. As far as the borrowing powers are concerned, I do not think that that would be a sensible thing to do. If we are to have genuine freedom among NHS providers, that is exactly what it should be.

Can I say to the Secretary of State that I fully support the concept of foundation hospitals because of the responsible freedoms that it gives to the management of the trusts that are applying for foundation status? The Macclesfield acute hospital, which is part of the East Cheshire NHS trust, is interested in foundation status. It is a three-star trust and hospital. Will he give that application a fair wind?

The hon. Gentleman has a track record of supporting national health service principles and institutions. He has been closely associated with the NHS in his local area. Of course, we will consider all the applications favourably. He knows that, to date, 32 NHS trusts have applied for NHS foundation trust status. I am currently assessing those applications. We intend that, over a four to five-year period, every NHS hospital should have the opportunity of becoming an NHS foundation trust hospital, precisely so that it has the opportunities and freedoms that go with improved performance in the NHS. We set that out in the NHS plan. We said that there would be a process of earned autonomy. The more performance improves, the more freedom will be earned in the NHS. When I meet NHS staff, managers who are responsible for running local services and representatives of local communities, they all say that they want the ability to get on with the job of providing improved, responsive services to the local community. That is precisely what we should encourage.

Given the official Opposition's policy on the NHS, does not their enthusiastic support for foundation hospitals give my right hon. Friend cause for the slightest concern about his proposals? Should not we concentrate on our successful policy of ensuring that all NHS services are brought up to the highest possible standard rather than allowing the 30 or so allegedly best performing hospitals effectively to become free-standing health corporations?

I think that my hon. Friend knows that that is not our policy. Much mythology surrounds NHS foundation trusts. I do not believe that it applies to my hon. Friend, but people initially claimed that only half a dozen or a dozen NHS foundation trusts would be formed. That is not and has never been the case. Our intention is to ensure that every NHS trust gets the opportunity to become an NHS foundation trust. We will put in place the measures, support and assistance, including the extra financial help that is needed, to help raise standards of performance of organisations that are frankly not doing as well as they should.

What will the effect of the proposals be on hospitals that are already in difficulties, for example, the Royal United hospital in Bath? There is no problem with its surgical, medical or nursing care, but it has huge historic problems with disastrous management. How does such a hospital compete when it has a financial millstone round its neck every year? How does it get to the starting point?

No Labour Member suggests that NHS hospitals should be forced to compete. That happened in the old NHS internal market, which I helped to get rid of. I certainly do not advocate bringing it back. I know about the problems in the hon. Gentleman's area and in the Bath hospital. Some hospitals are in a different position from others and we therefore need different strategies according to the hospital's individual circumstances. The hon. Gentleman knows that the history of underperformance—not by the staff who are doing a fine job in difficult circumstances, but sadly by the people in charge of the hospital—is the reason for our advocacy, through the NHS franchising system, of bringing in new management to turn the hospital around. When we have operated the franchising policy and brought in new management, it has had a dramatic impact on the performance of the relevant hospitals.

I think that I ought to try to make a supportive comment at this stage. My right hon. Friend knows that I am attracted to some of the Government's ideas that he is exploring, although there are other aspects of this policy that I am profoundly worried about. Will he clarify the confusion over the eligibility for trust membership? I have a close personal friend—who is known to one or two other people here as well—who has, to my knowledge, been in hospital in at least 10 different locations in the last three years. According to the guidance in the Bill, he would be eligible to stand for election as a trustee in all those separate hospitals. Could he do that, if he were so motivated—he is certainly very motivated—and will my right hon. Friend clarify the exact constituencies that will be used to elect the boards of trustees?

I know that my hon. Friend takes a close interest in these issues, and that he is attracted by certain aspects of the proposal if not by the proposal in total, although I keep working on him and trying to persuade him that it is a good idea and not a bad one, and that it is very much in keeping with the values to which both he and I subscribe. On his specific question, he will be aware, having read the Bill, that the governance structure of NHS foundation trusts works like this: the majority of places on the board of hospital governors are reserved for members of the local community. It is possible for an individual NHS trust, in putting forward its proposal to become an NHS foundation trust, to extend the franchise still further—for example, to patients who have used the hospital in question—but that will be a matter for the NHS trust to determine. My hon. Friend will also be aware that places on the board of governors are reserved for members of staff, which is important precisely to ensure that local members of staff, who, in the end, are responsible for delivering the services, also have some control over how those services are delivered. Finally, the primary care trusts will also be represented on the board of governors, precisely to address the concerns that were raised earlier. That must be right, because if we want to move to a system that has more locally responsive NHS services, we have to have greater local democratic control. It is good enough for local leisure centres; it must be good enough for local health services.

If he will make a statement on waiting times for angiogram services. [109810]

The national service framework for coronary heart disease goal is for a maximum three-month wait for angiography. NHS and New Opportunities Fund capital investment totalling £125 million is now putting in place more than 80 new or replacement angiography suites to support faster diagnosis. Ensuring rapid reductions in angiography waiting times is a priority for the three-year local delivery plans.

I am grateful for that answer, but could I just tell my hon. Friend about the case of one of my constituents? He was in hospital recovering from a heart attack and was due to have an angiogram a day later. He was then discharged, however, and returned home. He subsequently received a letter saying that it would be more than a year before the angiogram would be carried out. I have taken the matter up with the health authority and it tells me that one of the reasons that it is not going to be able to meet its heart surgery waiting time targets is because of this huge blockage in getting diagnoses through angiograms. Will my hon. Friend do all that she can to ensure that our commitment to better and faster treatment is matched by a commitment to better and faster diagnosis?

My hon. Friend is absolutely right. The whole of the patient journey has to be improved in terms of access to services, whether that involves diagnostics or treatment. I know that there has been a particular problem in his area. It lost one of its cardiologists last year, but that vacancy has now been filled and it has funding for a third consultant in that field, which should mean that the angiography should be able to proceed much more quickly. I would say to my hon. Friend, however, that in 1997, only 52,000 angiograms were carried out in this country, compared with the 80,000 carried out in 2001. There is, therefore, clearly more capacity in the system, but we have to build on that even more to ensure that patients get treated as quickly as possible.

Does the Minister agree that, when dealing with patients with heart disease, the sickest must be treated quickest? Does she at least acknowledge that there is a danger that, in meeting elective angiography waiting time targets for the least urgent patients, critical patients could be made to wait longer? Does she think it sensible or ethical, for example, that a patient with critical ischaemia who is at risk of heart attack or sudden death should wait at home for weeks for a day-case slot for angioplasty, or occupy a hospital bed for days or even weeks, running the same risk, while waiting for an angioplasty? What is the Minister going to do about that distortion of clinical priorities?

The hon. Gentleman knows well that clinical priority is always the most important issue in the national health service. He will also know that, because we set targets for heart surgery, this year there will be a maximum six-month wait for such surgery. We have now set targets for angiography. Those targets, together with performance monitoring, shows that we are determined to bear down just as hard on the diagnostic part of the patient journey as on the surgery part. The hon. Gentleman says that targets are not the right way to proceed in the NHS. He will know as well as I do that without targets thousands of people who need heart surgery would not be seen. He knows fine well that clinical priority is always the most important issue for the NHS, but we need to ensure that we make progress at every stage of the patient journey.

What resources the Health Protection Agency will devote to bio-defence issues; and if he will make a statement. [109811]

The Health Protection Agency brings together for the first time the combined resources of the key organisations to fight potential threats to human health. The level of activity and resource deployed against biological threats will vary depending on the nature and scale of the threat.

I am grateful to the Minister for that answer, but does she recognise the concern that, because the Health Protection Agency deals with all infectious diseases, including AIDS and tuberculosis, bio-defence is only a small part of its responsibilities? Is it right to have separate responsibilities for bio-defence for our armed forces and for the civilian population? What reassurance can the Minister give that bio-defence, which is vital at this difficult time, will get real attention from the Government? Would it not provide more reassurance if we had a specific Minister with responsibility for homeland security, including bio-defence issues?

This is an extremely important issue, and I am delighted to give the reassurance that the hon. Gentleman seeks. We are bringing together in one agency all the different agencies that have been responsible for chemical and biological issues, including the Public Health Laboratory Service and the Centre for Applied Microbiology and Research, as recommended by the chief medical officer in his strategy "Getting Ahead of the Curve". That brings together the skills, expertise, knowledge, facilities and resources, so that our services for health protection can be much more effective than they would be if they were spread out over a number of different agencies, as in the past. Whether the threat is naturally occurring, such as SARS, or a deliberate release of a biological agent, the same good, robust public health systems must be in place for notification, surveillance, reporting and treatment. Thanks to the NHS and the new Health Protection Agency, services in this country are some of the best in the world.

When highly contagious diseases were much more common in Britain than they are now, the national health service had the capacity to cope. We even had isolation hospitals, which are now closed. Given the pressure on capacity throughout the national health service, can my hon. Friend assure me that we could provide the beds to cope with a serious outbreak of a disease such as SARS without resorting to the measures that China is having to adopt by building extra capacity?

I am happy to give my hon. Friend that assurance. We have 25 centres with specialist cross-infection facilities. So far, the strategy that we have adopted in this country is proving extremely effective. We ensure that the whole of the NHS has proper information, is on alert and is in touch daily, and we provide the public with information about what they can do. That enables us to contain cases. We give people suspected of SARS appropriate treatment and ensure that they are isolated, so as to minimise the contacts that they make.

What proportion of targets in the NHS plan relating to primary care he expects will not be met. [109813]

None.

Given that the Minister and his Department are now more than half way through their four-year period to deliver the Government's health targets set in 2000, none of which has yet been assessed, surely he cannot dispute that it is proof of the Government's incompetence that he will not say which of those targets he expects not to meet. What confidence can the tax-paying public have that the Government will meet any of these targets when the Department's own figures show that it missed a whopping 31 per cent. of the 1998 targets, scandalously failed to give any information on a further 27 per cent. of those targets, thus missing a staggering total of 58 per cent., which is more than half the Department's 1998 targets?

The hon. Gentleman seems to think I said things that I did not say. I said "None".

We now come to the main business. I inform the House that I have selected the amendment in the name of the Prime Minister.

I beg to move,

That this House expresses its deep concern at the collapse of community services in Britain and the adverse effect on social inclusion, neighbourhood renewal, regional prosperity, and the quality of community life; condemns the policies of the Office of the Deputy Prime Minister, which have resulted in the unfair distribution of local authority grant, causing divisive regional disparities, and centralised decision-making and services; regrets that the only solution the Government has to these problems is an expensive unnecessary additional layer of regional government; further condemns the Government's failure to improve local health care provision by tackling the necessary reform of NHS services; deplores the absence of policies to protect rural communities from the effects of the deep recession in farming; and recognises the Government's total failure to protect community services, resulting in a crisis in school funding, an increase in violent crime, a deteriorating transport system, and a threat to important local services including community pharmacies, sub-post offices and residential care homes.

Given that crime is decreasing, when the right hon. Gentleman talks about the crippling effect of the fear of crime, is he not guilty of stoking up the fear of crime and creating the crippling effect?

Let us start with the fiction favoured by the Government—that crime is going down. The crime figures about which the hon. Gentleman talks are based on the crime survey, which, as he should know, does not include much drugs crime or crime against youths; the so-called victimless crimes. All those crimes are omitted. As a result, the figures underestimate the level of crime. If the hon. Gentleman wants a test of the real index of crime, he should go and talk to people in his constituency and find out whether they believe that crime is going down.

Is my right hon. Friend aware that, as the Rowntree Charitable Trust pointed out, people are in so much despair about the detection of crime that they no longer bother to report it? That is one of the reasons why crime appears to be going down.

My hon. Friend is right. Another reason is that fewer police officers are on the streets today to fight crime. Across the country, local police stations are closing to the public. As the hon. Member for South Dorset (Jim Knight) should know, here in London a decision has been taken to close Hampstead police station outside office hours. Clearly, criminals in Hampstead only ply their trade from nine to five.

Before the right hon. Gentleman moves away from policing, I draw his attention to the example of Blackpool, where the Tower project is in operation. Police forces from all over the country are coming to have a look at what is happening there. The police are working with the health service, doctors and voluntary organisations to address the needs of drug abusers. That has achieved a substantial reduction in crime. Blackpool is an example of a town where the community does exist and where people work together. The multiplicity of agencies working together has led to a huge reduction in crime.

That was an interesting mini-speech; almost an advert for the hon. Lady's local council. Sadly, of course, Blackpool has many other problems, but I want to return to the questions of crime and of police on the streets, which the hon. Lady did not mention. Until we have more police officers on the streets fighting crime—with the burden of form filling removed from their shoulders—and until we have true neighbourhood policing in this country, we will never be able to reclaim our communities for the honest citizen. That is what we are committed to; an extra 40,000 police officers on our streets. That is a real and necessary commitment that we will meet and which this Government will not.

Will the right hon. Gentleman join me in welcoming the increase of more than 300 officers in the South Wales force since 1997, and the fact that six officers in Maesteg are funded under the Communities First scheme? Will he also welcome the opening of the Maesteg police station, and of a substation in Ogmore Vale? All that has happened in the past few years. Will he join me in congratulating the South Wales force?

I thank the hon. Gentleman for drawing that to my attention. I shall return to the question of local police funding in a few moments, and he will hear what I have to say on the matter then. However, so much for policing for the moment. How many other local services are under threat? Those services include local care homes, railway branch lines, community pharmacies and, of course, the post office network. In recent weeks, my postbag—like the postbags of many other Opposition Members—has been filled with letters of concern about closures of local post offices. Across the country, hundreds of smaller post offices are threatened with closure because of the Government's decision to force people to have their benefit payments paid into their bank accounts.

Will the right hon. Gentleman reflect on the fact that, during his party's period in office, 3,500 post offices closed?

I am more impressed by the size of the Minister's folder than by the dimensions of his comment. Let us put the matter exactly in context. In every year of the previous Parliament, the Government closed more post offices—548—than at any time in the Parliament before that, under the Conservative Government, when the figure was 100. The Minister's figures are nonsense.

Will my right hon. Friend now reflect on the fact that the post offices that closed under the previous Conservative Government were mainly the result of demographics as people's shopping habits changed? They did not close because the Conservative Government deliberately withdrew the means of funding for the payment of benefits, as the Labour Government have done.

My hon. Friend makes a very good point. Post offices are closing entirely because of the Government's actions and their unwillingness to deal with the consequences of those actions. The Government's heavy-handed actions are not confined to post offices.

Is my right hon. Friend aware of the case of the post office in Flimwell in my constituency? The postmistress was robbed twice in the past month. The Post Office is holding her responsible for half of the money taken in the more recent robbery. It has issued an ultimatum to the Cutmores, who run the office, to hand back more than £1,000. The way that they are being treated is obscene, and the people in Flimwell are certain that there is a hidden Labour agenda to close the rural post office network.

My hon. Friend makes a good point about the treatment of one of his constituents. It is a serious point, and Labour Members should take it seriously. He also raises a point to which the Minister may wish to reply. At his last Question Time, I asked the Deputy Prime Minister about the behaviour of the Post Office and whether it was true that it had an incentive programme for its management to close more post offices. Surprisingly, he did not know, but he told me that he would write to me. Then he told me that the Secretary of State for Trade and Industry would write to me, but nor did she know the answer. Then the Post Office sent me an answer full of such Orwellian, managerial gobbledegook that I can assume only that the answer was yes. May we have a proper answer today? Does the Post Office plan to close as many post offices as it can?

"Parish councillors have done a superb job for nothing over the years. Now they simply won't come forward."

indicated dissent.

The Minister says I should take it; perhaps we will.

Might the right hon. Gentleman be interested in the following snippet from Susan Axford, a Conservative candidate, who said:

"This is in spite of massive additional government grants to councils such as Birmingham."?

I rest my case.

The Minister for School Standards is sitting on the Government Front Bench, but my right hon. Friend has not mentioned the impact on areas that face substantial new housing of the funding crisis that is forcing many local schools to make teachers redundant. How will schools find places for people moving into the areas affected by the house building?

That will clearly be a problem in the areas to which the communities plan applies, but it is a problem elsewhere, too, and I shall return to it.

Will the right hon. Gentleman give way?

I think that it would be a kindness not to.

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The hon. Gentleman had his chance.

As the right hon. Gentleman claims that the Government have rigged the grant system to reward inefficient Labour councils, will he tell us whether his local authority of the East Riding of Yorkshire is an inefficient Labour council, as it has received an increase in grant of more than 8 per cent. this year?

It is in no overall control, I am sorry to say, but that may change. Since the Minister mentions my area, I shall ask him for an answer. Why do schools up and down the country face deficits between £100,000 and £240,000 because of the Government's settlement? Those words are not mine, but those of a leading headmaster in East Riding.

Does my right hon. Friend agree that there ought to be greater transparency? Is he aware, for example, that Lichfield district council raised its council tax by only 3 per cent., while the Labour-controlled Staffordshire county council increased council tax by 18 per cent.? Because district councils collect the council tax, there is sometimes confusion. How can we make it clear that Conservative councils put council tax up by less than others but deliver more?

My hon. Friend makes a good point on the general question of transparency. I predict that the Minister for Local Government and the Regions will tell us that everyone received an increase above inflation. That would be appropriate if the requirements on councils were the same every year and if they faced the same level of costs years on year, but that is precisely what is not happening.

Does my right hon. Friend recall, from his recent visit to Eastbourne, the palpable anger of people there who face a 38 per cent. rise in the local council element of council tax, which is the fourth highest in the country? My constituents suffer from Labour meanness nationally and Liberal Democrat incompetence locally.

My hon. Friend makes a good point. I am sorry that only two Liberal Democrat Members are in the Chamber to pay attention to it. If there were more of them, they might learn a lesson.

Is the right hon. Gentleman aware that Cambridgeshire county council, which is Conservative controlled, is very pleased with its education funding allocation? It is one of the authorities that has benefited enormously from the redistribution of funding, which is a much fairer system than the previous one.

I am happy to hear that, but it is sad for the rest of the country. The issue is not confined to a single area. I referred to Plymouth, and earlier I mentioned my county, where there are good schools that have strong traditions and perform well but face possible redundancies as a result of shortfalls of between £100,000 and £240,000. That arises entirely from the Government's funding arrangements.

My right hon. Friend may want to contrast the situation in Cambridgeshire with that in Oxfordshire, where the average deficit for each secondary school is £114,000. Some schools have deficits of £250,000. One head teacher wrote to tell me:

"I have been a teacher for 27 years…in all my years of experience I have never known such a critical situation in school budgets."

My hon. Friend is entirely right. We have seen the unfortunate spectacle of the Secretary of State for Education and Skills attempting to persuade people that the funding shortage in local schools is nothing to do with the Government—the point made by the hon. Member for Cambridge (Mrs. Campbell)—but everything to do with local councils. It is like watching the Iraqi Information Minister putting on one of his more spectacular performances—and about as convincing.

Is the right hon. Gentleman aware that, in at least one local education authority, 160 more teachers are employed than in 1998? That local education authority is the East Riding of Yorkshire council—in the right hon. Gentleman's constituency.

No doubt that is why a leading spokesman for the area's head teachers said that the Government settlement was the worst that he had ever seen.

Will the right hon. Gentleman give way?

No, I must make some progress.

It is nice to know how good things are in the East Riding of Yorkshire, but does my right hon. Friend realise that, in Essex, the Government are giving away less with one hand than they are taking away with the other through national insurance increases and other costs that they have imposed. There will be teacher shortages in Essex during the next year. In my constituency, almost every primary school—[Interruption.] The hon. Member for Plymouth, Sutton (Linda Gilroy) is shouting statistics. They do not matter. Next year, children in my constituency will not have enough teachers to teach them. That is a fact and it is the Government's fault.

My hon. Friend is right. The sad thing about those statistics is that such figures have tragic implications for the lives of young children and their education. The damage done will be impossible to recover.

Will my right hon. Friend give way?

No.

I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:

"commends the Government's policies on community services and applauds its commitment to neighbourhood renewal, social inclusion and the quality of urban and rural community life through the protection and enhancement of key local services; further applauds the Government's achievements of a stable economy, improved economic prosperity and social justice, increased community services investment, reduced crime and safer communities; welcomes this year's increased funding for education of over £2.6 billion, 11.6% extra, and more than £250 million greater than pressures; notes that since 1997–98 spending per pupil has risen in real terms every year compared with a 4% real terms cut between 1992–93 and 1997–98; further welcomes the Government's NHS and social services modernisation to devolve power and resources locally to Primary Care Trusts and to end delayed discharges from hospital; notes that between 2003–04 and 2005–06 social care funding will grow in real terms by 6% per annum on average, building on the improvements already made to community services through the 20% real terms increase since 1997; welcomes this year's fairer funding of local government, producing, for the first time ever, an above inflation grant increase for every local authority and region in England, with a 25% real terms increase in grant since 1997, compared with a 7% cut under the last 4 years of the last Conservative government; notes that Conservative councils have imposed on average 16.2% increase in council tax; and condemns the cynical opportunism of trying to blame the Government for irresponsible tax increases by Conservative councils."

"the collapse of community services…and the adverse effect on social inclusion, neighbourhood renewal, regional prosperity and the quality of community life".

Does the Minister think that there is not one penny of waste to be cut out of the public services? Is he totally complacent?

If the hon. Gentleman will bear with me, he will hear a great deal of what we are doing to improve efficiency, to drive up standards and to ensure that we get real value for money. A 20 per cent. cut across the board in public services, however, to which the Conservative party has pledged, is a recipe for the decimation of our services, which will damage communities all over the country.

I have always judged the right hon. Gentleman to be a man of principle, so I cannot understand why he is putting to the House something that he must know is not true.

All that I am doing is repeating the pledge given by the Leader of the Opposition, who made it perfectly clear, towards the end of last year, that the shadow Cabinet were looking to make 20 per cent. savings out of public expenditure. That was a public commitment. I am happy if Conservative Members wish to denounce their party leader, but it was a commitment that he gave.

The Minister should know—I am not accusing him of lying—that he is spinning a Labour lie; there is not a single shred of truth in it. What is true, however, is that his Government have stolen £13.4 million from Worcestershire county council in the name of resource equalisation. That theft alone of £13.4 million has forced the county council to put up the council tax by more than the rate of inflation.

The hon. Gentleman is wrong on both counts. The Leader of the Opposition made it perfectly clear in a statement just before Christmas that the shadow Cabinet were looking for 20 per cent. savings in public spending. Conservative Members may wish to denounce that, and may be embarrassed by it—I would not be surprised if they were—but that was what was stated. If those pledges were put into practice—

Read it out.

Order. The hon. Gentleman should not shout across the Dispatch Box.

Thank you, Mr. Speaker.

I give way to my hon. Friend the Member for Reading, West (Mr. Salter).

I do not know whether my right hon. Friend the Minister has had an opportunity to read the "Reading Banner" produced by Reading Labour party. If so, he would be able to pray in aid the following quote:

"We are looking at the target of 20 per cent. savings across the board in government spending."

I am grateful to my hon. Friend. I was about to quote The Daily Telegraph of 31 December, which contains exactly the same pledge:

"The shadow Cabinet are looking at the target of 20 per cent. savings across the board in Government spending".

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I shall give way once more to the hon. Member for Buckingham (Mr. Bercow).

Given the litany of public service woes that were so eloquently described by my right hon. Friend the Member for Haltemprice and Howden (David Davis) and the fact that the vast majority of people identify principally with their parish, town, district or county, but not with the amorphous concept of a region, why does the right hon. Gentleman wish to create a nationwide network of regional assemblies on the absurd principle that our main problem in this country is that we are somehow under-governed?

I was very pleased to give way to the hon. Gentleman, and I am only sorry that the right hon. Member for Haltemprice and Howden was not willing to offer him a similar courtesy in the course of his speech. Our regional policy is one of extending choice—those regions that want to elect regional assemblies will be able to do so. Unlike the Tory party, we do not have preconceptions. It said that it was opposed to devolution in Scotland, then denied that and changed its mind. It said that it was opposed to devolution in Wales, and then changed its mind. It said that it was opposed to the people of London having the opportunity of an elected city-wide authority, but it has now changed its mind. I give the hon. Gentleman a forecast: the Tory party's opposition to elected regional assemblies in England will crumble in just the same way when the people of certain regions-I do not pretend all regions in England demonstrate that they want to have an elected regional assembly. We are giving the people that choice.

rose—

I give way to the hon. Member for North-West Norfolk (Mr. Bellingham).

The right hon. Gentleman mentioned damaged communities, but has he looked at the case of St. Edmund's community primary school in my constituency where the very hard-working and loyal headmaster has just resigned? He said:

"The Government has let us down. This is the worst settlement in living memory. I've had enough because the Government is undermining public services."

Let me tell the hon. Gentleman about funding for Norfolk. When his party was in power— [Interruption.] Let me tell him the facts. When his party was in power, Norfolk county council, which is responsible for education in his part of the country, received an average increase in grant of 2 per cent. per annum in the last three years of the last Conservative Government. The average grant that Norfolk county council has received in the last three years is 5.7 per cent. Will he go back and tell the person whom he has quoted that the figures demonstrate that this cannot be the worst settlement that Norfolk has ever received, because it is almost three times the level that was given when the hon. Gentleman's party was in control?

I am grateful for the Minister giving way while he is on the subject of cuts in schools budgets. Can he explain why, this morning, Dame Jean Else, the head of Whalley Range high school in Manchester, threatened to resign rather than sack 20 of her 165 staff, because she is facing a budget shortfall of £600,000 as a result of what the Government are doing?

Manchester has received, on average, over the past three years an increase in grant of 4.9 per cent.

rose—

Let me encourage Conservative Members to contain themselves. [Interruption.]

Order. I cannot allow hon. Members to shout across the Chamber.

Thank you, Mr. Speaker. I understand the frustration of Conservative Members. They do not like hearing the truth. However, when their party was last in power, Manchester city council did not get the 2 per cent. increase in grant that Norfolk got. It got no increase at all. That demonstrates how the Tory party let down education authorities all over the country.

When the Minister reads out the increases in settlement for each local authority, will he at the same time read out the increasing costs for each local authority in terms of employer national insurance contributions, pensions and salary costs that his Government have caused through their centralised policies?

I am very happy to tell the hon. Gentleman that we have increased funding by £3.8 billion overall for local government. The increase for education is £2.6 billion and that is a good £250 million more than the combined impact of all the additional pressures to which he has referred. Additional money is going in, and we are well aware that, in individual areas, there are difficulties. This year has been one in which there have been many changes. As he will know, there have been changes to the overall grant-giving formula and changes to try to reduce ring-fencing—a point that the right hon. Member for Haltemprice and Howden made in his speech. I am pleased to say that we are reducing ring-fencing but, as a result of that, the standards fund, which is a ring-fenced fund, has now been rolled into the general formula for standard spending share. That change inevitably produces distributional consequences and, at the moment, we are seeing some of the consequences together with issues that have been well debated.

rose—

Will hon. Members contain themselves, as I am trying to give a serious answer to a serious question? All the changes result in different impacts in different areas. That becomes even clearer when it comes to individual schools. It is precisely for that reason that my right hon. Friend the Secretary of State for Education and Skills and my hon. Friend the Minister for School Standards have been doing a great deal of work with us to try to ascertain precisely the position in every local authority. My right hon. Friend will make a statement after the local government elections to help move things forward and to ensure that the difficulties where they exist—we accept that there are some areas where there are difficulties—are properly addressed in a sensible and rational way and not with the rhetoric and sweeping blanket condemnations that are unrealistic and unworthy of a party that did not adequately fund education in its years in power.

The Minister is not answering a very good point. Why does he not undertake to publish the cost pressures on all the schools in the country? These are the predictable national insurance costs, pension costs and the costs that result from the change to the pay structure. They are perfectly calculable and every school has calculated them for itself. Why does he not do that for every authority in the country so that we can see the results? The issue that we are talking about affects not just one or two schools, but hundreds of schools and it is doing serious harm. He owes it to the public to tell them the truth on this matter.

There is an interesting contradiction between the thesis that the right hon. Gentleman put forward in his speech as to why Government were not letting individual communities get on with it and his wish, in an extraordinary Stalinist vision, to have us publish the figures that would detail every cost pressure for every school in the country. He will know that all the factors that I have described—the factors relating to increased pay, increased pension provision and the increased national insurance plus the changes from ring-fenced to general grant and factors such as changes in the school roll—have differential impacts in different schools. It is right that local education authorities, which are better placed to gauge the position, should discuss the matter with their schools. Government, of course, have an interest, and that is why I said that my right hon. Friend the Secretary of State for Education and Skills and my hon. Friend the Minister for School Standards are doing work to ensure that we are better informed about where there are pressures. They have already made significant contributions to help those authorities facing pressures. The extra money that is being given in London and to schools facing particular pressures is all part of that positive response.

Does my right hon. Friend agree that the biggest single factor putting pressure on education budgets is the 5.15 per cent. increase in employers' pension contributions that has been necessitated to clean up the mess that this Government inherited from the 1990s when local authorities were allowed local control and some teachers who should have gone through competency procedures and possibly been sacked were given ill-health early retirements or redundancy retirements with enhanced pensions from the age of 50 upwards? That local control left the teachers pension agency in a huge hole financially and central Government have had to step in this year to sort out the problem.

My hon. Friend makes an absolutely correct and fair point about the significant impact of teachers pension provision. That is one of the key pressures that I identified.

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I should now like to make some progress.

"every single waiting time and waiting list national indicator is more positive than in 1997."

On the subject of local government settlements, will the right hon. Gentleman promise the House that he will hold an urgent meeting with Fiona Millar, a chairman of governors in London, who has complained about the fact that the local government settlement has moved money from the south-east to the north? If he does not know where to find her, I advise him to look in 10 Downing street, where she works as personal assistant to the Prime Minister's wife.

I am little surprised that the hon. Gentleman has not been paying attention to the needs of his constituency. He will know that Buckinghamshire county council is one of the southern Conservative councils that did extraordinarily well out of the settlement because it received a 6.4 per cent. funding increase. He and his colleagues continue to peddle the myth that money is being transferred to the north despite the fact that many Conservative councils in the south of England are doing very well indeed. He would do rather better to acknowledge what is happening in his area.

Will the right hon. Gentleman give way?

Of course I shall give way to the hon. Gentleman. He has a good connection with Wandsworth council and I hope that he will deplore the unreasonable council tax increase.

One of the Minister's annual mistakes is to consider percentages rather than bills on the doorstep. The bills landing on the doorsteps of Wandsworth are the second lowest in the country and the council's services, by the standards of the Government and the local people, are among the best.

The hon. Gentleman makes a brave effort to conceal the fact that Wandsworth borough council has simply been up to a bit of crude electioneering by cutting the council tax in an election year and whacking it up the next year.

rose—

Hon. Members should wait and hear what I have to say. Tory North Somerset has chosen to increase its council tax by 15.4 per cent., compared with increases of less than half that set by the other three councils in the area—Bath and North East Somerset, which is under no overall control; Bristol, which is Labour-controlled; and South Gloucestershire, which is under Liberal Democrat control. The Conservative council alone pushed up its council tax by disproportionate amounts. The conclusion is clear—Tory councils cost people more. Look at the average council tax this year. In Tory authorities, it is £1,008; in Liberal Democrat councils, it is £934; in Labour authorities, it is £818. This year, council tax increases in Tory authorities are 16.1 per cent.; in Liberal Democrat councils, 10.5 per cent.; and in Labour councils, 10.7 per cent. That tells a story—Tory councils cost people more.

On behalf of my right hon. and hon. Friends, I extend our condolences to the Deputy Prime Minister. Taking up the Minister's final remarks, I agree that the Conservative motion could have been tabled by Opposition parties active in the 1980s and 1990s. There is a lot of truth in it—there are problems in our communities up and down the country, and Conservatives are right to point them out. However, the problem for the Conservatives is that they caused many Of those difficulties when they were in government. The problem for the Government is that they are copying many Conservative policies and are not addressing those difficulties. In their bare-faced cheek in tabling the motion, the Conservatives demonstrate that they want completely to reinvent history. They talk about centralisation in the motion, but one must remember what Conservative Governments succeeded in doing to local government financial settlements—rate-capping, ring-fencing, compulsory competitive tendering, the uniform business rate, standard spending assessments, credit approvals in the borrowing regime, supplementary credit approvals and, of course, the poll tax. That plethora of measures introduced by the Tory party centralised the way in which local councils are funded and caused many problems that the Government have not yet addressed.

"we would change the system when we come back to office".

On a point of information, although there is a category of qualified teachers, other teachers are counted, including teachers from foreign countries with qualifications equivalent to English qualifications.

I am grateful to the Minister, but that is not the whole story, as I think he knows. The Government include some unqualified teachers in the definition that they are using and I hope that they will make that clear later.

The hon. Gentleman is getting to the nub of the argument and has highlighted a great mystery. On the one hand, the Government are talking about massive increases in education spending, but on the other hand, all our schools are facing a crisis. Does not the Government amendment provide a clue to where the money has gone, as it talks about £2.6 billion or 11.6 per cent. extra for education, but then talks about

"more than £250 million greater than pressures"?

The hon. Gentleman is right. We must see those figures in order to judge the Government's performance. We in the House are not very good at analysing budgets. I am concerned about the lack of financial scrutiny in the House. On this occasion, we must demand to see the figures. The underlying causes of the cost pressures are many. The national insurance increases and the pension transfers alone are adding an extra 5 per cent. to most school budgets.

The hon. Gentleman speaks of the national insurance being an extra pressure. Did not his party support the Government when the House voted on the increase in national insurance? Did he not go through the calculations before he voted for it, to see what it would mean for the public sector?

The hon. Lady is right: we wanted more money in the health service. The fact that the Conservatives voted against that rise in national insurance means that they are proposing cuts to the health service. They complain about the Government accusing them of 20 per cent. cuts, but the fact that they voted against that tax rise, which is funding more money for our health service, proves that they want to cut public services across the board.

"I am struggling to come to terms with a deficit of about £145,000. For a small special school this is, of course, extremely damaging and will have long term implications.

I have already informed my staff that all professional development, inclusion activities with mainstream schools, educational visits, equipment and resources etc. will be absolutely minimal. It looks as if I will have to cut staff by two teaching assistants and two teachers.

For a special school with such a good reputation as St. Philip's … the severe cuts in provision will have a very damaging effect on my children and the LEA will have to send more children out of borough at high costs."

"Along with my colleagues in the Royal Borough of Kingston upon Thames I must express my concern over the level of funding that we have received for the financial year 2003–04.

Compounded with the drop in Standards Fund we, like the majority of schools in the borough, are facing the prospect of cutting our staff at a time when we need to be increasing the pupil/teacher ratio in order to comply with the ever increasing demands made on us … So often we are dismissed as a leafy suburb with no real problems—I am sure you understand that this is far from reality in many of our schools."

My hon. Friend's point must be underlined. Rural areas like mine in Cornwall and those of my colleagues in Devon are facing the same problem. I challenge any hon. Member in any part of the country, whatever the political composition of the LEA, not to agree that letters are coming in from heads and governing bodies on the same lines as those received by my hon. Friend.

My hon. Friend is right. When the Minister for School Standards replies to the debate, I wonder whether he will tell the House how many letters have been written to the Department. I bet it has been inundated with letters of complaint from head teachers and school governors around the country.

As I said earlier, my right hon. Friend the Secretary of State for Education and Skills has made it clear that he intends to make a statement about his analysis and understanding of the current position as soon as the local govt purdah period is over. That will be on Friday. It is in everyone's interest that that statement should be public at the earliest opportunity, rather than waiting for the House to return on Monday, but I have no doubt that the issue can be debated in the House at a future date.

I am sure that other right hon. and hon. Members share my concern that that information will not be given to the House. The Minister may be right to say that it needs to be given early, but that only shows the magnitude of the crisis. If the Government must make the announcement on Friday because it cannot wait till Monday, they are admitting that there is a huge crisis in the funding of our schools. Why do not Ministers make the statement now? I am sure that the Conservative party and our party will agree to suspend local election purdah, as we agree that there is a crisis.

The Minister appears to have a diary problem. Of course, the House will not sit on Friday, and it is bad enough that the statement will not be made when the House is sitting, but we will not be able to debate it on Monday, because Monday is a bank holiday.

The hon. Gentleman makes a very fair point. I assume the Minister meant that we would debate the matter on Tuesday. Can he confirm, for the benefit of all Members, that an oral statement will be made to the House? Ministers shrug their shoulders as though it were an unimportant issue about which hon. Members were not concerned. Surely the debate today shows that it is important and that hon. Members want to debate it at the earliest opportunity.

The hon. Gentleman is hypothesising about the future plans of the Post Office, but does he agree that he needs to give us the evidence on which he is basing his assertion? Many people in our communities might be deeply worried about the threat to their post offices that he seems to be imagining.

I have been trying to fight some of the post office closures in my constituency, which has involved me in many discussions with senior Post Office managers in which I have tried to change their minds and make them understand the local services that post offices deliver. It is clear from their attitude that they are getting fed up with individual campaigns, and I think that they will return and deal with closures en masse. Those of us who are elected to represent our areas should be very worried about the effect on important community services.

I hear it said from the Labour Benches that people are being looked after in their own homes. Perhaps Labour Members would be interested to know that Department of Health figures show that, in the past six years, the number of people being cared for in their own homes has decreased by 25 per cent., so significantly more than 125,000 fewer people are now being cared for in their homes. Does that not demonstrate that the Labour party's approach to prevention is resulting in people no longer getting the care because of the tightening of eligibility criteria and the increase in charging for services, which are denying access to those services to too many people?

My hon. Friend is absolutely right. He has done an awful lot of work to expose some of those problems. The Government have taken a chaotic approach to managing the care homes sector, in which many homes have been lost without any plan or way of replacing that care in people's own homes or by other methods. Interestingly, the Royal College of Nursing has taken up that cause in its conference this week. It has identified the link between the health service and the impact on hospitals and the need for more care home beds for the elderly, and it is concerned that the Government need to act.

I am grateful to the hon. Gentleman for giving way. Since the advent of the so-called fairer charging policy and the Government's refusal to fund its implementation, is he aware that thousands and indeed tens of thousands of people throughout the country who can in no sense be described as rich or prosperous are, as a consequence of Government neglect, facing 200, 300 and 400 per cent. increases in costs for the services on which they desperately rely?

The hon. Gentleman is right. Many elderly people cannot afford care and are becoming increasingly reliant on their families. If they do not have families, they are relying on neighbours, and if they do not have friendly neighbours, they are going without basic care.

The hon. Gentleman says that a local income tax is a fair tax, but can he explain to the House how it would be fair to require a council such as West Somerset district council, which has only 30,000 residents, to have its own tax inspectors? Is he not really telling us about a hidden agenda for regionalisation?

I am afraid that the hon. Gentleman is completely wrong. There would be no need for his authority to have tax inspectors, which shows how much he does not understand the policy. He should talk to the Conservatives who are operating in local government. For example, he should talk to Sandy Bruce-Lockhart, a very senior Conservative local government politician. He and his colleagues in Kent are coming round to the argument and recently supported a motion in Kent county council in favour of considering the introduction of local income tax.

Will the hon. Gentleman give way?

No, I shall not.

It is a pleasure to follow the Front Benchers in this debate. I am disappointed that the shadow Deputy Prime Minister—I think that that is the title in which the right hon. Member for Haltemprice and Howden (David Davis) glories—failed to take my intervention. It was most churlish of him and I assure Opposition Members that I shall return his generosity, should they seek to interrupt this short and, I hope, not too contentious contribution.

"the collapse of community services in Britain and the adverse effect on social inclusion, neighbourhood renewal, regional prosperity".

"further condemns the Government's failure to improve local health care provision".

"recognises the Government's total failure"—

"total failure to protect community services, resulting in a crisis in school funding".