What advice he has given to hospital trusts in respect of measuring the 2004 accident and emergency four-hour wait targets. [116524]

We have issued detailed guidance on how to measure the number of patients attending accident and emergency departments, and the number of those patients seen, treated and admitted or discharged in four hours or less from arrival. All trusts with an A and E department are required to measure and report these numbers.

But patients are no better off for being treated in other parts of the hospital while being taken off the four-hour wait times, and they are still being treated on trolleys. The recent BMA survey showed that both before and after the monitoring period in March, A and E departments met much lower thresholds. Doctors are worried that the process is distorting clinical priorities. Does not the Minister share my concern that hospital trust administrators are finding ever more inventive ways of treating targets rather than patients?

No, I do not. The hon. Gentleman knows that the Royal Cornwall hospital, part of his local trust, is taking positive steps towards the A and E target and exceeding it, because of the new medical assessment unit that is in place and because of the £2 million that the trust has put in to establish a new ward. People should not wait longer than four hours in our emergency departments. His trust and trusts around the country are making tremendous progress on the target that we set for the end of 2004.

In an emergency, a four-hour wait for a liver to turn up for a transplant can be too long. Will my hon. Friend ask the Crown Prosecution Service to stop the prosecution against a senior ambulance driver for ferrying a liver, and will he consider the possibility of amending the law to exempt transplant vehicles?

I have sympathy for my hon. Friend's constituent. Clearly, the case is before the court and it would be wrong of me to comment on it at the Dispatch Box. We wait to see what determinations are made.

Is not the Minister embarrassed about the number of trusts that are forced to cheat to meet the target? Is he not concerned that the British Medical Association survey showed that a majority of respondents in A and E felt that the measures taken

"had distorted clinical priorities … and many said that waiting times for patients with the most serious conditions had increased."

"patients were being rushed through A & E, inappropriately admitted, or transferred to the wrong department."

The hon. Gentleman knows that the BMA surveyed only 30 per cent. of its members. Only the Liberal Democrats could think that that was a majority. It is not a majority, and indeed the BMA did not survey all trusts. There has been tremendous performance towards the A and E target that we set for the end of next year, because of the hard work, dedication, innovation and commitment of nurses and doctors in our A and E departments across the country. There has been investment and the target has focused and concentrated minds. The hon. Gentleman should make a distinction between the extra resources and capacity that go into trusts to achieve that milestone and those targets, and the fiddling, which is a disgraceful accusation to make of nurses and doctors across the country.

My hon. Friend will be aware that A and E services have been monitored over many years by community health councils, which are due to abolished at the end of August. Could he explain to the House why CHC staff received a letter this weekend indicating that they will not be made redundant within the three-month period as they expected, and what the statement that the Department is to make later this week will tell us about the future of CHCs and their replacement bodies?

My hon. Friend is right that by independent monitoring, CHC staff made a great contribution to our A and E departments through casualty watch. There are on-going discussions with the Association of Community Health Councils for England and Wales and CHC members about that. I shall make a statement in due course about the issues that my hon. Friend raises.

The Minister must accept that the entire monitoring exercise on A and E was a charade. The hospitals knew when they were to be measured, and they knew that they had to meet the Government's targets or they would be punished, because this is the "Targets R Us" Government. More importantly, the majority of doctors—not just those in the BMA—have said that the waiting time for those with more serious conditions went up during the monitoring period, and that operations were not scheduled at all or were cancelled. In effect, patients suffered so that Ministers could take credit. What does that say about the moral foundations of the Government's policy?

The milestone focuses minds. It means that hospitals across the country put in investment, resources and innovation to ensure that people are waiting no longer than four hours in our A and E departments. Does the hon. Gentleman want to return to the situation under the Tories, in which people were waiting six, seven, eight or nine hours in our A and E departments? Does he want to return to trolley waits in our A and E departments lasting 24 or 36 hours? Of course not. When he quotes the BMA, he is being selective. The chairman of the BMA's A and E committee said:

"Many of the doctors surveyed were proud of the level of service they provided in the week of monitoring"

What fantasy is this—the idea that no patients are waiting more than four hours? Simply because the Government fiddle a survey, it does not mean that that is what is happening in the real world. In the real world, extra staff were taken on, staff were asked to work longer shifts and patients were shifted from one part of the system to another. It is not us who are undermining the staff, but the Government, with their constant interference and imposition of targets on them. The targets are now the only thing that matters, irrespective of their effects on doctors, nurses or patients in the system, and no matter what the distortions of clinical priorities. As long as Ministers are kept happy, that is the main thing. We have seen the waiting list figures fiddled and the star ratings distorted, and while the Prime Minister struggles with his 45 minutes to Armageddon and the Chancellor plays fantasy economic growth, the Secretary of State is doctoring the casualty figures. Is it any wonder that in this country it is not only Cabinet Ministers who feel that they are being duped?

It was a milestone set for the end of March. That is very straightforward. The target is for the end of the year, next year. There has been improvement month on month in our A and E departments since September. As to the hon. Gentleman's suggestion that that figure for the end of March was not sustainable, we saw average improvement in April as well.

Will the Minister reflect on the fact that, if we are trying to ensure sensible use of A and E services and maximise throughput, the corollary is that minor injuries units must be effective? Like many hon. Members, I am concerned that minor injuries units that are seen, rightly or wrongly, as a substitute for some withdrawn A and E services, should have the maximum availability in terms of hours. Will he please address that issue and, in particular, consider the Orsett hospital in Thurrock, where the minor injuries unit is not open to a sufficient extent in terms of compensation for my constituents?

I shall undertake to do that. My hon. Friend will know that minor injuries units and walk-in centres make a tremendous contribution to emergency services and should sit alongside mainstream A and E services, medical assessment units, clinical decision units and a lot of other initiatives to ensure a quick throughput in our A and E departments and across the board.

If he will make a statement on the provision of digital hearing aids. [116525]

Over the next two years, we are investing £94 million to make the benefits of digital hearing aids fitted as part of a modernised service available more widely on the NHS. All NHS hearing aid centres in England will be providing digital hearing aids by April 2005.

I am glad to hear it, but my constituents are concerned that they have to pay for digital hearing aids, while in wealthier places on the mainland, they are available free on the NHS. Will the Minister explain why she wrote on 27 May:

"If the services commissioned by a PCT…do not meet the needs of a particular patient, then GPs do also have freedom to refer elsewhere using the Out of Area …arrangements",

That is why it is important that everybody, wherever they live, gets access to digital hearing aids on the NHS. St. Mary's hospital in the hon. Gentleman's constituency is keen to take part in the modernising hearing aids scheme, and by April 2005 it will have the opportunity to do so. His constituents, along with those in the whole of England, will, for the first time, be able to get their digital hearing aids not by going private, but through the NHS.

My hon. Friend will be aware that there are some 2 million hearing aid users and perhaps another 2 million who should be using hearing aids. Will she take it from me that to move in three or four years from a position in which no digital hearing aids were available on the NHS to one in which they are 100 per cent. available is a highly commendable achievement? Does she accept that that speed of progress is related to the training and availability of audiologists; and will she assure the House that appropriate training and recruitment of audiologists is taking place to complement the measure?

My hon. Friend, who has some expertise, is absolutely right. It is important that we not only introduce new hearing aids, but support that with a modernised service so that people can have the checkups and preparation that are necessary to make the best use of digital hearing aids. We can do that, first, by helping staff to work in a different way and, secondly, by increasing the number of audiologists. My hon. Friend will be pleased to know that from this September, three additional degree courses for audiologists are starting, with more to follow in coming years. Those courses, which are funded by the Department of Health, will ensure that we have the staff in place to match the extra investment that will make the service available to people using the NHS in England.

Given that the principal logjam is in gaining access to an NHS audiologist, what progress is being made in giving private hearing aid dispensers access to the NHS contract for digital hearing aids?

I am interested not in encouraging people to go out of the NHS privately, but in enabling people within the NHS to get digital hearing aids for free. That is why we have started private sector pilots in Leeds and Shrewsbury that use capacity in the private sector to ensure that more NHS patients get digital hearing aids, and why we are developing a national framework contract to allow us to use capacity in the private sector for NHS patients.

If he will exempt from prescription charges people with mental health problems in need of continuing care or treatment. [116526]

Improving services for people with mental health problems is a priority for the Government. We aim to help those who may have difficulty in paying prescription charges, rather than extending the exemption arrangements. By using a prescription prepayment certificate, no one need pay more than £32.90 for four months, or £90.40 for 12 months, for all the NHS medication that they are prescribed.

I thank my hon. Friend for that answer. However, what does she make of the report by Mind and Health Which? on the hidden costs of mental health, which found that 83 per cent. of people with experience of mental distress had not received the care or treatment that they needed and felt that they could not cope with life or recover, and that 59 per cent. of them were unable to afford the treatments and drugs that were on offer? Does not that represent a lack of boldness?

The report is an excellent piece of work that is based on service users' experience. The Minister of State, my hon. Friend the Member for Redditch (Jacqui Smith), will meet representatives from Mind tomorrow to discuss the report's findings. It covers not only medication and prescriptions, but psychological therapies, art therapy and complementary therapy.

Is the hon. Lady aware of the survey conducted by the Depression Alliance which showed that up to 50 per cent. of those suffering from mental problems are now turning to herbal medicines, and to aromatherapy in particular? Does she not think that it would be helpful if the certificates to which she referred could encompass herbal medicine and aromatherapy, to help those affected? Is she not also absolutely ashamed of the Food Standards Agency report on vitamin supplements, which has caused such confusion? Does she agree that many doctors prescribe and encourage patients to take vitamin supplements, and that the idea that the whole nation is on the same quality of diet is absolutely ridiculous?

The hon. Gentleman is fully aware that primary care trusts can now commission a whole range of therapies, because they have the resources at the front line of the service. He is also aware that there has to be a proper evidence base for those therapies to be provided. Continuing to raise the game of complementary practitioners is an important part of the service and increasing regulation. In the mental health field, a whole range of therapies is beginning to be evaluated, and the involvement of people with mental health problems in arts projects, for example, is proving extremely helpful in alleviating some of their problems and symptoms. So this is not just a matter of traditional complementary therapies; a whole range of alternatives is beginning to be offered under this Government to people with long-term mental health problems.

Will my hon. Friend assure the House that the Government will take note of the Mind report's recommendations and consider implementing them? Where gaps in provision are found—perhaps research needs to be commissioned to identify them—will the Government take steps to ensure that those gaps are filled?

As I have said, the Mind report is an extremely useful piece of information based on service users' experience. I would draw Members' attention to its recommendation on ensuring that, in accordance with the Mind prescribing protocol, people with mental health problems are involved in the clinical decisions about the kind of medication that should be prescribed. Time and again, we have found that when we get expert patients involved, the medical outcomes are much better. The Mind protocol is an excellent piece of work and we shall certainly look at all the report's recommendations to see what we can take up.

If he will make a statement on the measures being taken to tackle the deficits of (a) the Worcestershire acute hospitals trust and (b) the South Worcestershire primary care trust. [116527]

The West Midlands South strategic health authority is currently working with both trusts to ensure a return to financial balance at the earliest possible opportunity. This will be helped by an increase of more than 30 per cent. in the resources available to the South Worcestershire primary care trust in the period 2003 to 2006.

I thank the Minister for that answer. Despite the increase in resources of which he speaks, however, the South Worcestershire primary care trust is consulting on a range of painful options involving cuts in the local health service, including downgrading the minor injuries unit at Evesham community hospital, and the Worcestershire Acute Hospitals NHS Trust is suffering in a real struggle to bring its large cumulative deficit back into balance. On three occasions, Ministers have refused to answer my parliamentary questions on when the hospital trust will be obliged to write off its cumulative deficit. It is important for the doctors and nurses at the hospital to know what cuts in their services might be threatened, in order to bring the deficit down. I would ask the Minister—[Interruption.]—I have asked this question three times before; this is the fourth time. When will the hospital trust be obliged to write off its cumulative deficit?

I understand the hon. Gentleman's concerns about the health service in his constituency. He will know that NHS regulations require trusts to restore financial balance within three years of the deficit arising, and that is the time frame within which his local trust must operate. I hope that that answer is helpful to him. As he is not being partisan today, I would like to offer him this comment in an equally non-partisan spirit. I hear his concerns about the resources going into his local NHS—we all do, on this side of the House—but I would simply ask him to reflect on the plausibility of his critique, given that his party voted against the resources going into the national health service at all. I hardly think that he is in a position to bemoan the lack of resources going into the NHS in Worcestershire when he and his hon. Friends voted against the increases.

Will my right hon. Friend conduct an urgent review of the services provided by Worcestershire acute hospitals trust and South Worcestershire primary care trust to see exactly what the impact of a 20 per cent. cut in funding would be on those services?

I am not sure that I need to carry out a thorough review to decide that. Such a cut would be devastating for the NHS in my hon. Friend's constituency, and the one sure way to prevent it from happening is to make sure that that lot never get returned to office.

What response does the Minister plan to make to the highly critical report from the president of the Royal College of Surgeons, which has just been issued, on the situation at the new Worcestershire hospital?

I have not had the chance to read the report, but, like all reports written by the president of the Royal College of Surgeons, I will study it very carefully indeed.

How candidates for membership of governing boards of foundation hospital trusts will be chosen; and if he will make a statement. [116528]

The Health and Social Care (Community Health and Standards) Bill states that members of each NHS foundation trust board will be chosen by election. Direct elections will help to ensure that NHS hospitals work more closely with the local communities they serve.

I am grateful for that reply. Although I have no objection in principle to my right hon. Friend's plans to devolve power within the NHS, I still struggle to understand his proposals on accountability. How will candidates be selected? Will they nominate themselves or will they be chosen in some other way, as yet undecided? Is there not a danger that, if we are not careful, we shall end up with foundation hospitals that are less rather than more accountable to the public they serve? I know that that is not what he is aiming at.

My hon. Friend is right about that. The principle is that we want to ensure that local staff and local members of the community have a greater say in how local hospitals such as his own, which have applied to become an NHS foundation trust, are run. That must be right. If we are to achieve more responsive local services, with the best will in the world, that cannot be imposed from Whitehall or from the top down. There has to be a much greater local element of accountability than there has been to date.

I welcome the Secretary of State saying that he wants to encourage the widest possible membership of foundation hospitals. In that spirit, will he consider extending membership to all people on the electoral roll in the relevant area? If he does not want to go that far, will he tell the House what active measures he will take to promote wide membership, which many of us would welcome?

The right hon. Gentleman makes a fair point. It is important that the membership of NHS foundation trusts is as large as possible, representing the local community. There are a number of options, and one is to achieve that through advertising in the local media, which would encourage local people to become members. Alternative options include allowing people to register to become a member of an NHS foundation trust when they register, for example, to vote in a local election.

Can my right hon. Friend explain this to me? If a specialist hospital such as Christie in my constituency becomes a foundation hospital, who will be the electorate for membership of it?

As my right hon. Friend and I have discussed previously, the position of specialist hospitals is somewhat at variance with that of most district general hospitals, for example. [Interruption.] Although the hon. Member for Woodspring (Dr. Fox) laughs, he is the first to say that the NHS is not a uniform service. Indeed it is not. Specialist hospitals have a very different make-up and serve a very different catchment population from district general hospitals. That is why it must be right, as the Bill does, to allow some flexibility in the governance structure.

Will the Secretary of State reflect on criticism from the Labour-dominated Select Committee on Health? It said that the plans for the constituencies to elect the governing boards would be determined by unelected NHS organisations. As a result, the Committee said that the board of governors would function simply as focus groups, advisory panels or talking shops. On reflection, does the Secretary of State not think that it would have been better to be more consistent in deciding on the constituency bodies that would elect governing boards, and thus to avoid confusion, anomalies, disappointment and a system that prevents the boards from carrying out their functions effectively?

That sounds suspiciously like a return to precisely the centralised control and Government intervention that the hon. Member for Woodspring warned us against a moment ago. The hon. Member for West Chelmsford (Mr. Burns) is a member of the Select Committee as well as a Conservative Front Bencher—[HON. MEMBERS: "Surely not!] Indeed he is.

I am multi-skilled.

That is one way of putting it, although I am not sure it is the most appropriate.

What expansion of primary care facilities are (a) under way and (b) planned in the Elmet constituency. [116529]

A significant amount of investment is being undertaken in East Leeds primary care trust—some of it at the Allerton Bywater and Kippax health centres in my hon. Friend's constituency, where new facilities are planned for the coming year. Other PCT investment will improve and expand primary care facilities in the area, and increase the range of services available to local people.

I am glad to learn that, as we speak, work is in progress in my home village of Allerton Bywater. Perhaps my hon. Friend has been furnished with the list including Wetherby and Swillington, whose health centres are also to be improved. Does she agree that, although hospitals may be considered more glamorous, we should never lose sight of the fact that the facilities provided by PCTs, and those who work in them, should be a Government priority when it comes to investment?

My hon. Friend is absolutely right. For most of us, PCTs are the front door to the NHS, and it is from them that we and our families receive most services. It is through them that the NHS has an impact on our lives. That is why the extra £1 billion that the Government are investing in primary care over the next three years is so crucial. It will have an impact on my hon. Friend's constituency and on the constituencies of all Members, regardless of whether they voted for the money in the first place.

If he will make a statement on NHS primary care trusts' deficits at the end of 2002–03. [116530]

Audited accounts for primary care trusts for the year 2002–03 will not be available until the autumn. Local health services, however, received an average cash increase of just under 10 per cent. for that financial year.

What comfort can the Secretary of State give Stockport PCT, which reports that it is rolling forward a deficit of £2.5 million into the current year and is now committed to a programme of £6 million of financial reductions in that year? My constituents face reductions in access to magnetic resonance scans, ophthalmology services and minor surgery, and my GPs face a £600,000 reduction in their prescribing budget. Will the Secretary of State ensure that Stockport's health service has the resources that it needs to restore those services to my constituents?

My understanding is that at the end of this financial year, Stockport primary care trust will deliver a balanced budget. Secondly, over the next three years it will receive increases of 9.13 per cent., 8.88 per cent. and 8.57 per cent. Those are cash increases for the local PCT—which, of course, is a lot more than the Liberal Democrats ever promised for the health service.

The extra resources given to PCTs are very welcome indeed, and as my right hon. Friend will know, the GP contract is out for voting among GPs. That is an important part of the Government's plan for improving primary care, but I ask him to reassure my GP colleagues that the GP contract really is a step forward in improving recruitment and retention, and to ensure that the extra resources given to PCTs really will find their way through to GP surgeries. The worry remains that some of the money given to PCTs never gets as far as it should, and that GPs and their patients do not get the benefit that they ought to.

My hon. Friend makes an extremely good point, and I know from my discussions with GPs and primary care organisations that this issue is a real cause of concern for them. However, there are guarantees that the money will get through—presuming, of course, that GPs decide to vote yes in a ballot that the British Medical Association will be holding. My hon. Friend will be aware that the new contract negotiated between the NHS Confederation and the BMA represents a real step forward not just for GPs but for NHS patients—not least because it guarantees a 33 per cent. increase in funding for primary care services. Such funding is long overdue and will make a real difference to GP surgeries throughout the country.

The Secretary of State will know that many of these debts and deficits are the result of past mismanagement by a small number of NHS trusts and health authorities. Does he think that the burden of that should be borne by local service users or spread more evenly over the whole of the NHS?

The hon. Gentleman raises an important point. As he is aware, the way out of the financial difficulties that arose in his own area, for example, was for it to borrow NHS resources from other areas that underspent on their budgets in a particular year, so it cannot be right simply to wipe the slate clean, thereby penalising those areas that have managed their budgets properly. We need the right incentives in place to ensure that, in all parts of the country, financial management is always given the priority that it deserves. Equally, as the hon. Gentleman is aware, we are making extra resources available, through the NHS bank, to areas such as Avon, Surrey, Sussex, Bedfordshire and Hertfordshire, in which particular financial difficulties have arisen.

Has the Secretary of State had a chance to read the letter from Dr. Neil Coleman of the Avenue Medical Centre, in Slough, a copy of which I sent to him? Dr. Coleman says that it would be possible to state that if the new contract can work in his practice, with high disease prevalence, it can work in any practice throughout the country. He also volunteers the Avenue as a pilot programme for the new contract. Could the Secretary of State spread this enthusiasm to other areas, in order to develop the contract?

I will do my best. Although there has been controversy about the new contract, when GPs see the detail they will understand how they will benefit. Of course, their surgeries will benefit and there will be additional financial investment, but like most people working in the national health service, family doctors are after an improvement in services to patients. Crucially, that is precisely what this contract offers.

If he will make a statement on waiting times for MRI scans. [116531]

A patient's clinical condition will determine how long they may have to wait for a scan. Emergency cases need to be seen immediately; other cases will be carried out as quickly as possible, depending on the clinical priority of all patients waiting to be scanned.

In my local district general hospital there are 800 sick people, all of whom have been waiting for more than eight months for a diagnostic scan. How much credibility does the Minister attach to the staff's explanation that although early diagnosis is crucial in avoiding life-threatening diseases, it is given low priority by health service administrators because such diagnosis means more patients, longer waiting lists and missed targets? Will she investigate this potentially serious distortion of clinical priorities?

Early diagnosis and early treatment are top priorities for the Government, because it has been shown that they result in much better health outcomes for patients. That means increasing capacity, and I can tell the hon. Gentleman that the New Opportunities Fund has provided for 57 extra MRI scanners and cancer plan funding for 50 extra MRI scanners and 50 CT scanners—a vast improvement in the amount of modern equipment in our NHS, which will enable many more scans to be carried out. In 2001–02, the last year for which figures are available, an extra 73,000 scans were carried out in this country to secure early diagnosis and much better treatment. Capacity is improving, and the hon. Gentleman's local hospital was provided with a new CT scanner in April this year, which should go some way towards improving the local position.

I thank my hon. Friend for her advice and for outlining an interesting programme to the House. However, I know of patients in my constituency who are diagnosed early, but for whom it takes months rather than weeks to have the MRI scan. Is she satisfied that the equipment is being used to its full advantage, and if not, will she ensure that it is?

My hon. Friend makes an important point. As well as making more equipment available, we also need trained and qualified staff to operate it, and we have increased the number of radiotherapists in training by 55 per cent. We are also working on programmes to enable assistant and advanced practitioners to carry out procedures that were previously carried out only by radiologists. A report published today on pilot programmes carried out across the country shows that radiographers can extend their skills and make a real contribution to shortening waiting times for patients, which is so important.

Ninety-five per cent. of patients attending hospitals for scans require diagnostic imaging services that are delivered by radiographers. However, last year the Audit Commission found that 250,000 patients had to wait up to five months for MRI scans, with an estimated national shortage of 5,000 radiographers. Since then, the Royal College of Radiologists believes that the position has deteriorated. Given that new recruits are simply not entering the profession, that too many radiologists are leaving early and that the Society of Radiographers has just become the first health service union to vote against "Agenda for Change", which would have meant a working year that was three weeks longer without extra pay, how on earth is the Minister going to meet her new recruitment targets by 2004 and bring down waiting times for scans without counting it as yet another top priority?

The hon. Gentleman has a cheek, in view of the cuts in training places—not just for radiographers, but for GPs, doctors, nurses and a whole range of services—that took place under the Conservative Government. We are not only turning around those cuts but securing growth in the service. Radiotherapy training places are now up by 55 per cent. from 1997 levels. Furthermore, radiographers are welcoming the new ways in which they can extend their skills. [Interruption.] If the hon. Gentleman listens to the information that I am providing, he might learn something. I urge him to read, in detail, the report on radiography published today, which shows that projects on skills mix have enabled advanced practitioners to interpret X-rays. They can now put the markers on the X-rays, which identify where breast lumps are, and other practitioners can carry out basic radiotherapy. It is not just about increasing capacity, but reforming and redesigning how the service works, using imagination and creativity, which the hon. Gentleman lacks.

Is not one way of improving services that require expensive machinery such as MRI scanners to extend the hours of operation, assuming that we can secure the staff to carry out those tasks?

As usual, my hon. Friend makes a good, practical, down-to-earth and common-sense suggestion. The Audit Commission found that the majority of machines were being used for more than 10 hours a day, but we can do much more to achieve round-the-clock working. Through "Agenda for Change" and the changes to the pay system for consultants, we need to ensure that we have flexibility in the system so that we can make maximum use of our theatres, diagnostic equipment and the new investment that the Government are putting in to the national health service.

What assessment he has made of the need for greater provision of respite care. [116532]

Carers make an enormous contribution to our country and to those for whom they care. We have supported carers through new legislation and by increasing funding to provide support and services. In particular, the carers grant will more than double to £185 million by 2006. That will provide 130,000 more short breaks for carers.

I thank the Minister for that answer, but does she agree with Mencap that those who care for young people—who may need more attention as they grow older—need more help in the form of respite care? Will she try to assess the unmet need and also talk to ministerial colleagues in Northern Ireland about the situation there?

The hon. Gentleman makes an important point. I am aware of Mencap's work, and it is partly why this year the learning disability task force—on which Mencap works with us, in the person of its chief executive, who plays an important role—has been asked, along with the implementation team that works to develop the points set out in "Valuing People", to concentrate on how we can ensure that the general progress that we are making for carers includes those caring for people with learning disabilities. They, too, need access to the better services and deserve the support that can be provided.

The hospice movement provides terminal and day care, as well as the respite care to which the question refers. Have the Government moved closer to the commitment by successive Governments to match the amount raised by voluntary funding with contributions from the taxpayer? Many adult hospices are struggling. Staunton Harold hospice in north-west Leicestershire closed some months ago, and it was a major provider of respite care for that area and for south Derbyshire.

I strongly agree with my hon. Friend about the important role that hospices play in respite care. That is why we have increased funding for palliative care, through NHS funding, by an unprecedented amount. We have also ensured that when the money goes into the system—the extra £50 million, for example—it gets through to benefit those who provide that important service in hospices and more widely through palliative care.

What is the Minister doing to make carers aware of the provision of respite care, so that they can take advantage of it? What education is she providing about carers assessments, which ensure that their needs are met?

The hon. Gentleman will know that under the Carers and Disabled Children Act 2000 carers can receive an assessment of their needs. He makes an important point about the need to provide better information. We support Carers UK financially, to help it to run its helpline. We also support the learning disability helpline, alongside Mencap, to which about a quarter of the callers are carers. We also support some innovative ways of reaching carers, including the ring-around carers scheme, which uses telephone conferencing to ensure that carers are aware of their new rights to assessments and their ability to access some of the increasing investment that is being made to support them.

Millions of people care for their relatives and friends 24 hours a day, seven days a week and 52 weeks a year. They save the state millions, if not billions, of pounds, and ask for little in return. Does the Minister agree that the least that we can do is to provide respite care for those carers at the time that they deem that they need it?

My hon. Friend makes a very important point. He is right: carers make a massive contribution to this country and to the people whom they serve. In fact, six carers out of 10 have suggested that short breaks are often their most effective support. To enable us to provide such breaks, the Government have doubled the amount of money going through the carers grant. In addition, we must make sure that the provision is more flexible. That is why we issued regulations—I think just last week—to develop the short-break voucher scheme. It is now easier for local authorities to issue carers with vouchers for their breaks, so that carers can take breaks at times, and with providers, that are more flexible and useful for them. However, my hon. Friend is right. The Government will do all that we can to support carers and the vital work that they do in our communities.

When he expects the new GP contract to come into force. [116533]

If he will make a statement on the contract for GPs. [116536]

The general practitioners committee of the BMA is currently balloting GPs on the new general medical services contract. Subject to approval and the passage of the necessary legislation, we hope to begin implementation of the new contract next year. The new contract will bring significant benefits to both doctors and NHS patients, by rewarding improvements in care and by widening the available range of primary care-based services. The new contract will also mean that expenditure on primary care will rise from £6.1 billion this year to £8 billion by 2006.

I thank the Minister for that answer, but will he admit to the House that negotiations on the GP contract have been a complete and utter shambles? Last year, 66 per cent. of GPs threatened to resign if a new contract was not negotiated successfully, and the Minister was able to ensure that the BMA would ballot members only by inserting a minimum practice guarantee. How long will that guarantee be in place, and who will decide when it is no longer necessary?

No, the negotiations have not been a shambles. The contract was negotiated by two parties, the BMA and the NHS Confederation. The result has been a good deal for GPs and for NHS patients. I hope that the hon. Lady will join me in urging GPs to endorse the contract, because of the significant benefits that it will bring. We have made it clear that there will be no time limit on the minimum practice guarantee. It is not part of the new arrangements that any practice should lose out financially. Quite the opposite: there are significant financial benefits for GPs, and reciprocal benefits for patients. The hon. Lady should exhibit her usual good grace and welcome what is an important development for primary care, in her constituency and in the NHS as a whole.

The Minister will know that the ballot result is expected on 20 June, and that the Standing Committee considering the Health and Social Care Bill will conclude proceedings on 19 June. If he intends to use the Bill as a vehicle for primary legislation to implement the contract, will he extend the time available in Committee, so that the provisions can be scrutinised by a Committee of this House, rather than only in another place?

I wish that it was in my gift to extend the time available for consideration in Committee, but it is not. The Bill has to be reported by 19 June. With the best will in the world, there are some things that I cannot do, and unfortunately turning back time is one of them. I wish that I could do so. Given that the House has decided that the Bill must come out of Committee on 19 June, and that the ballot result will not be in until 23 June, in fact, our only opportunity to debate the measures and table amendments will come when the Bill returns on Report. That is what we intend to do.

Will my right hon. Friend accept that some GPs in Burnley believe that they need better premises to take full advantage of the new contract and to offer the full range of primary care treatment, as the Government intend? Does he accept that there is a shortage of funds, and that some GPs are being told that they will have to wait five or six years before they can offer that range of treatment? Will he perhaps meet me to discuss the possibility that additional money might be made available to get the contract accepted and to meet the Government's treatment requirements?

I am grateful to my hon. Friend and I will certainly look into the situation in Burnley that he described. However, I echo the point made earlier by my hon. Friend the Minister of State: because of the additional investment that we are making available to the NHS, the primary care estate—the building blocks in primary care—will receive an additional £1 billion of investment over the next few years. That will help to transform many GP surgeries up and down the country. I agree with my hon. Friend—if that is what his GPs are saying—that if we want to provide the best possible quality primary care services, we must provide the best possible primary care buildings, and that is precisely what the Government are doing.

The Minister will be aware that he has already been accused by GPs of meddling in the negotiations over the proposed contracts and that his intervention at the time of the emergency conference in May was reported to have swung a crucial vote against the negotiating teams, so now that the ballot is actually going ahead, will he confirm whether he is planning to intervene again to impose the contract unilaterally if the vote goes against?

The hon. Gentleman has waited 55 minutes to ask what is probably the most puerile question that we have heard from the Opposition Front Bench. I made no such interventions. He should not believe everything that he reads in the press, for heaven's sake.

What steps he is taking to speed up financial flows in the NHS to hospital service providers. [116534]

As my hon. Friend is aware, local primary care trusts now control 75 per cent. of the total NHS budget. In deciding where to spend that resource, it is important that PCTs do so in partnership with local hospitals and strategic health authorities. To that end, local negotiations over this year's budgets in most parts of the country are now complete.

I am grateful to my right hon. Friend for that answer, but he will of course understand that specialist hospitals, such as those in the north-east in Newcastle and Sunderland and on Teesside, may have dealings with up to 20 primary care organisations, some of which are quite slow in paying, with resulting problems; and that every improvement in those specialist services may have to be signed up to by up to 20 of those primary care organisations, with all sorts of slowing down of innovation and improvement. What can he say to hospitals in that position, which want to move on and to be sure that the money for service improvements is there?

My hon. Friend is well aware, not least from his own close working relationship with the health service in Newcastle, that specialist hospital trusts, such as the Freeman and the Royal Victoria Infirmary in Newcastle, provide a range of services, which are, as he rightly says, not just district general hospital services, but more specialist tertiary services as well. Inevitably, therefore, those hospitals are in negotiation with a number of primary care trusts. In such situations, what normally happens is that one local PCT has the responsibility of becoming the lead commissioner and acts on behalf of a number of local PCTs. If that is not happening in my hon. Friend's area, I shall gladly look into the matter. He might also like to be aware that the NHS bank will shortly be conducting a review of how money flows around the system, precisely to ensure, first, that it gets to the front line, and secondly, that it does so in a timely way that does not jeopardise the provision of front-line patient services.

Does the Secretary of State agree that one of the keys to speeding up financial flows is the balance between management and front-line staff? Can he confirm his Department's figures showing that the number of qualified nurses in the NHS is 266,170? Is it true that, for the first time, that number has been overtaken by the 269,080 managers and support staff'?

I think that the hon. Gentleman is trying to count as managers and bureaucrats people in professions such as painters, decorators, gardeners and cleaners. With the best will in the world, not even he could believe that those people are bureaucrats.

If he will make a statement on the regulation of health care assistants. [116535]

The Government are committed to consult on proposals to regulate support workers, and that consultation will be taking place in the near future. The consultation will identify those categories of staff whose clinical practice needs to be of a high standard in order to ensure patient safety. The proposals cover a range of options, including full statutory regulation of those staff, and the Government will decide on the way forward in the light of responses to the consultation.

I thank the Minister for that answer, but I view the lack of urgency with which the Government are approaching the question as quite disappointing. Does he not accept that the increased use of such assistants without proper regulation exposes patients to risk and assistants to exploitation?

Regulation of health care workers in Scotland is a matter for the devolved Parliament, but generally, we will be making proposals. It is right that we think carefully about them when other issues, such as "Agenda for Change", are continuing in the rest of the United Kingdom.

What assessment he has made of the impact of treating patients from Wales on English waiting lists. [116537]

The provision of NHS services to Welsh patients by English NHS trusts is a matter for local NHS commissioners. The maximum waiting time for English patients will be six months for in-patient treatment and three months for an out-patient appointment by 2005. The setting of targets for Welsh patients is, of course, a matter for the National Assembly for Wales.

May I thank my right hon. Friend for that reply? However, I was hoping that he might have been able to tell me whether there was any capacity on the English side of the border for even more Welsh patients to be treated, given that the incidence of illness in Wales is much higher than it is in England.

I agree with my hon. Friend. It is obviously important that the NHS provides an integrated service across the border between Wales and England. If there is spare capacity in NHS hospitals in England, it is right and proper that NHS patients who live in Wales should have access to it when that can be agreed. In fact, that is precisely what is happening. The number of Welsh patients treated in English trusts is increasing substantially and is up from 26,000 in 2000–01 to 37,000 last year.