asked the Secretary of State for Social Services if he will make a statement on the progress of the implementation of the Mental Health Act 1982.

The Mental Health (Amendment) Act 1982 was consolidated with the 1959 Act into the Mental Health Act 1983, almost all of which was implemented on 30 September this year. The various orders and regulations that were required under the Act were made in the early summer and a full memorandum of guidance, new forms and leaflets for patients and their relatives were distributed during the summer. The Mental Health Act Commission has commenced work and has been undertaking visits, investigating complaints and providing second opinions required under the Act.

As, on 29 September, 316 people were in prison and yet, under the definition in the Act, were suffering from mental disorder, will my hon. and learned Friend try to achieve speedy implementation of sections 35 and 36, which relate to remands to hospitals for reports and treatment, and of section 38, which deals with interim hospital arrangements?

I share my hon. Friend's anxiety about the problems to which he has drawn attention. The Government are anxious to implement those parts of the Act. We shall consult the relevant authorities about the appropriate procedures to do that in the near future.

Does the Minister agree that it is utterly inappropriate that, at any one time, some 200 mentally disordered offenders are in prison when they would more appropriately be dealt with in hospital? What progress does he expect to make in removing them from prison and removing from special hospitals people who are awaiting transfers to National Health Service psychiatric hospitals?

The prison medical service and the Government are trying to achieve an improvement in both respects. I entirely share the anxiety that is felt about the matter. It is wrong that there are people in prison who should be receiving treatment in hospital. We have already brought into effect the provisions which oblige regional health authorities to help courts which want to place a mentally disordered offender. We must now implement the other provisions which my hon. Friend the Member for Billericay (Mr. Proctor) mentioned.

Will the Minister take note of section 2 (2), which excludes drug abusers? Will he amend the Act, or introduce new legislation, to ensure that the appropriate penalty, which was imposed on the Scottish brothers yesterday for pushing glue solvents, will be available in the rest of the United Kingdom, so that the evil merchants of death can be dealt with? Does he agree that young people should not be sent to hospital because other people are not in prison where they belong?

The problem of what is known as solvent abuse—glue sniffing—falls outside the legislation. My hon. Friend the Under-Secretary of State for Health and Social Security has been studying closely the problem of glue sniffing and hopes to make a statement in due course. I share the hon. and learned Gentleman's anxiety about the problem.

asked the Secretary of State for Social Services if he will estimate the level and cost of patient abuse of the National Health Service.

No, Sir. Responsible use of the Health Service helps us all by enabling it to work more effectively. I am sure that most people understand that, but there is at the moment no objective definition of abuse on which an estimate could be based.

Is my hon. Friend aware that there is a growing problem with patients not turning up for appointments at hospitals? Does he agree that that is a serious problem, which results in the waste of consultants' time and valuable Health Service resources? Has he any plans to deal with it?

I appreciate my hon. Friend's point. It should be pointed out there are some 37 million outpatient appointments in hospitals in any one year and it cannot be doubted that people not turning up for appointments cause inconvenience and waste money. At the moment, the problem is best dealt with by local initiatives in hospitals where the consultants and those who make the appointments can draw the attention of patients to the importance of keeping their appointments.

Does the Minister accept that one technical abuse of the NHS in urban areas is the use of casualty departments in general hospitals by homeless persons as a form of general practitioner service? Will the hon. Gentleman examine the Leeds experiment of providing a general practitioner service for homeless persons in the city and apply the lessons learnt elsewhere?

I shall consider the lessons that we can draw from Leeds. Many people, particularly in inner city areas, tend to use accident and emergency facilities rather than those of the general practitioner. That is one of the reasons why my right hon. Friend the Secretary of State recently announced an initiative to provide better standards of care in inner city areas where they are much needed, which has been broadly welcomed in the House.

Is my hon. Friend aware that some foreigners who come into Britain and use the NHS try hard to pay for the service that they receive but are prevented from doing so by the hospital administrators?

My hon. and learned Friend the Minister for Health is actively reviewing the situation.

Will the Minister accept that a more important form of abuse of the NHS is the abuse of its facilities by private hospitals? Was not the Prime Minister involved in the worst form of abuse by giving the impression, when she had her eye operation, that only the private sector could provide the necessary treatment, and not disclosing that the private hospital that she attended had to borrow vital equipment from the King Edward VII NHS hospital nearby?

That is a thoroughly silly question. The Government are bent on providing a better standard of health care for all. If that can be achieved in co-operation with the private sector, so much to the good.

asked the Secretary of State for Social Services what recent representations he has received in relation to the privatisation of catering services in the National Health Service.

We have received a number of inquiries from firms interested in NHS catering contracts since our health circular on competitive tendering for support services was issued in September.

Apart from the fact that some firms are looking for easy pickings from the contracts, will the Secretary of State note the recent comment by the vice-chairman of the Yorkshire regional health authority that the privatisation of catering services would lead to a reduction in standards and a loss of patient care? Given the disastrous experience of privatisation in local government, is it not about time that the Minister changed his policy of enforced privatisation and put patients first rather than profits for private companies?

The whole purpose of the policy is to put patients first. The Government's policy is that the private sector should be given the opportunity to tender for a range of services on a fair comparison basis. The whole point of the policy is that if savings are made they go to patient care. I should have thought that the hon. Gentleman would support such a policy.

Does my right hon. Friend agree that if we are to fulfil our pledge to cut taxes we must reduce NHS spending and reduce also the largest work force in western Europe, and that the only way to do so is to pursue vigorously a policy of privatisation?

No, Sir, I do not agree with all that my hon. Friend has said. The Government stand by the NHS. We wish to make the Health Service more efficient and effective. The NHS is a concept which the Government entirely support.

Is the Secretary of State aware that Trust Houses Forte Ltd. and Town and City Properties Ltd. are the two principal companies hoping to pick up the catering tab from the privatisation of the NHS, and they have shareholder lists that read like a roll call of the Tory party, including the former chairman of the Tory party, a host of Tory Members of Parliament, both past and present, and some Tory Ministers?

I can hardly compete with what my hon. Friend the Under-Secretary said, because that is another thoroughly silly question from the Opposition Front Bench. The point is that the money from savings by contracting-out is spent on patient care. I wonder what the hon. Gentleman thinks the Health Service is all about. It is a user. It is a service that is provided not for the providers but for patients.

asked the Secretary of State for Social Services how many staff in his Department have been involved in investigating cases of discrimination against disabled people which have been reported to him since the beginning of 1983; and if he will make a statement.

The bulk of the work on cases of alleged discrimination is handled by four staff in the Department, along with their other duties. But a number of other staff both in DHSS and other Departments have been involved in pursuing inquiries on particular cases which were relevant to their responsibilities.

What action can the Minister take when cases of discrimination against the disabled are reported to him? To be more precise, what powers does the Department have to deal with discrimination?

The main action that we take is to make further inquiries among those against whom discrimination is alleged. We then consider their response, and may follow it up with the person who made the complaint in the first place. I cannot lay down absolute rules, but we have sufficient scope for conducting effective inquiries.

Is my hon. Friend aware that, unfortunately, there are still far too many district general hospitals which do not have adequate toilet facilities for patients in wheelchairs and that the parking facilities offered by local authorities — particularly around city hospitals—are inadequate for disabled outpatients?

I am sure that my ministerial colleagues in the Department will have heard that. The Department of the Environment is now consulting on building regulations directed at that sort of problem in all new public buildings.

In a recent reply I was told that the Minister and his predecessor had looked at 18 cases of discrimination since 11 February. At the last meeting of the all-party disablement group in the House it was reported that The Spastics Society alone was in contact with between 500 and 600 serious cases of discrimination against disabled people. Why is it that The Spastics Society knows of so many cases while the Minister knows of so few?

The answer is that The Spastics Society has not passed on details to us or asked us to look into the matter.

asked the Secretary of State for Social Services what measures are being taken by Her Majesty's Government to combat discrimination against disabled people; and what has been the cost of the measures taken to date.

The main thrust of Government policy is to promote the integration of disabled people, and in that way to help overcome the obstacles they often face. I recently placed a lengthy list of the Government's activities in this field in the Library of the House following my reply to my hon. Friend the Member for Welwyn Hatfield (Mr. Murphy) on 18 November. It is not possible to identify the cost of all the Government's activities relating to this.

Given the Government's now stated objection to legislation which would outlaw discrimination against the disabled, will the Minister promise that there will be a programme of education and persuasion of the general public on the need to avoid such discrimination? Will he ensure that it is much more cost-effective than previous Government campaigns, such as the very expensive propaganda campaign to persuade people to wear seat belts when in the front seats of cars?

I hope that I made it plain during the debate on the hon. Gentleman's Bill that I am suspicious of generalised undertakings. The Government will continue to press ahead with what they are doing with regard to social security benefits, access, transport, employment and education, and to deal with specific practical problems which affect specific disabled people. We are making significant progress that goes far beyond any generalised undertakings that I could give to the House.

On a point of order, Mr. Speaker.

I shall take points of order after Question Time, as to deal with them now would lessen the time available for Questions.

It is a real point of order.

I shall take it after Question Time.

During the debate on the Bill introduced by my hon. Friend the Member for Liverpool, West Derby (Mr. Wareing) I suggested that deaf people were also discriminated against because there were too few programmes on television which used CEEFAX and other means of putting words on the screen, although the deaf still paid a full licence fee. I asked the Minister to look into that. Will the hon. Gentleman assure the House that he is looking into it, and what progress has been made?

I cannot give the hon. Gentleman a progress report now, but I shall certainly look into that. Although we would all like to see more being done, the extent to which the television companies, in particular, have developed their ability to add subtitles to programmes is very encouraging and is greatly welcomed by the deaf.

Leaving aside the Minister's implied criticism of The Spastics Society, he says that he is more interested in a campaign of education and publicity in this area than in legislation. How much is he prepared to spend on education and publicity? When shall we see the colour of his money?

I made no criticism, implied or explicit, of The Spastics Society. I simply stated the fact that we had so far received—the number has gone up by three since the debate—21 complaints of discrimination. One or two of those came from The Spastics Society, but we have certainly not had 500 or 600 complaints from it. As to the colour of my money, I wish to make one simple point. I said in the debate that I thought any money available would be better spent on direct help to disabled people. Since the debate I have announced proposals for a new social security benefit which will put £20 million more into the hands of 20,000 disabled people. That is what I mean by practical and flexible steps.

asked the Secretary of State for Social Services what are his current plans for current and capital allocation, respectively, of moneys to the Wessex health region over the next five years.

Wessex regional health authority will continue to benefit over the next five years from this Government's policy of redistributing revenue resources to regions which have in the past been less well funded or which face high growth in population. Wessex can also expect to receive a higher than average capital allocation per head over the same period.

I thank my hon. Friend for that most encouraging reply. Do I take it, and may I put it to the people of Wessex, that there is no question of any National Health Service cuts in Wessex?

Yes, my hon. Friend can certainly do that. The growth in revenue in the region since 1979–80, the year that we came to office, has been 8·4 per cent. After making provision for Health Service pay and prices, 1·1 per cent. growth was given to the region in 1983–84. We have no intention of making any cuts in Health Service spending in the area to which my hon. Friend referred.

While the Minister is looking at cuts in Wessex, will he also look al the cuts in the west midlands region?

Order.

It is nearby.

It is not as near as all that.

asked the Secretary of State for Social Services what further progress is being made by his Department in improving access for the disabled.

The Department is funding an independent Access Committee for England which will be based at the Centre on Environment for the Handicapped, a voluntary organisation with great experience in this area. The centre is consulting interested organisations on the precise membership and functions of the committee and expects comments back early in the new year.

I welcome my hon. Friend's setting up of the Access Committee for England. Will he ask the committee to consider the situation at DHSS offices, where there is often a lack of toilet facilities for the disabled and often access problems as well?

I shall certainly consider asking the committee to look into the problem. Meanwhile, I assure my hon. Friend that I am looking into it myself. The point was raised with me in relation to one office which I visited recently, and I have asked for inquiries to be made about that. We are anxious to do everything that we can to deal with the problem.

May I ask the Minister to treat this as a matter of great urgency? Is he aware that people not normally classified as disabled could benefit by better access, for example, those with arthritis, pregnant ladies and women wheeling prams? They would all gain. If that is so, and if millions stand to gain, will he intensify his efforts to make access readily available at all public places?

We are concerned to move as rapidly as we can. The access committee is only part of that effort. I have referred to what the Department of the Environment is doing on building regulations. The Department of Education and Science will follow that with design guidance for schools. The Home Office is considering a number of points on buildings with which it is concerned, and we have just referred to social security offices. What is needed is a co-ordinated effort, using every weapon that we can find.

Will my hon. Friend say something about the other part of the problem, which is to get an allowance that can be spent on wheelchairs most suitable to the needs of the disabled people concerned? Is this the committee that will have terms of reference covering that aspect?

It is not quite the same committee. I thank my hon. Friend for his interesting letter to me on this matter. As he knows, we have recently announced the establishment of a review of the artificial limb and appliance centres. That is very much the type of point that the review team will want to consider.

How many benefit offices that are used for appeals and tribunals are accessible to disabled people? Moreover, will the Minister take seriously the point that many outpatient departments of hospitals are inaccessible to the disabled?

I cannot give the figures, but I am conscious of the problem, which we are anxious to remedy.

asked the Secretary of State for Social Services what was the number of persons awaiting urgent in-hospital treatment at the latest available date (a) nationally, and (b) on Merseyside.

On 31 March 1983, 49,123 cases were classified as urgent awaiting admission to National Health Service hospitals in England, and a total of 1,032 such cases in the health districts on Merseyside.

Is it not a scandal and a disgrace, and a commentary on the competence and compassion of the Government, that so many thousands of people in agony and distress should be waiting for urgent hospital treatment, or dying on the waiting lists, when there are unused new beds and unemployed doctors and nurses as a consequence of the Government's mismanagement of the Health Service?

Since 1979 waiting lists have been reducing on Merseyside and nationally. Between 1974 and 1979, waiting lists increased by 52 per cent. on Merseyside. We have been struggling since then to bring the waiting lists down. The hon. Gentleman would have helped that progress if he had intervened with his trade union colleagues and friends on Merseyside during last year's industrial action.

In view of the national waiting list, will my hon. Friend confirm that the most difficult to tackle is the orthopaedic waiting list? In view of the recommendations of the Duthie report, will he undertake to have a close look at the proposed closure of the Bretby orthopaedic hospital in my constituency, which closure is being considered by the southern Derbyshire health authority?

The picture varies regionally. I shall examine my hon. Friend's submission.

If, as the Minister says, the number of people on waiting lists is falling, why did he not tell the Prime Minister of that massive advance so that she could use the National Health Service?

The hon. Gentleman has followed an earlier silly question by his hon. Friend on the Front Bench, the hon. Member for Oldham, West (Mr. Meacher), with another silly question.

asked the Secretary of State for Social Services if he will make a statement on his plans for the family practitioner services.

Proposals for changes in the general ophthalmic services and in the status of FPCs are included in the Health and Social Security Bill now before the House. My right hon. Friend announced on 17 November the planned level of expenditure on the family practitioner services in 1984–85.

I thank my hon. and learned Friend for that answer. Is he aware that the Government's determination to improve the cost-effectiveness of the family practitioner services is welcomed? In that regard, is it at least a possibility that the drug-prescribing habits of general practitioners will be audited annually?

We certainly intend to try to improve the drug-prescribing habits of general practitioners. We continue to encourage economy in the quantity of drugs prescribed and a greater use of generic prescribing. I agree that we must continue our efforts, because there is still considerable potential for savings to be made.

I thank the Minister for his answer to the hon. Member for Peterborough (Dr. Mawhinney). Does he agree that the lists could be further reduced by a process of directives for doctors when dealing with patients who need drugs?

There has been a steady increase in the number of practitioners and a reduction in list sizes, but that must be judged as part of an overall policy for general practice, mainly determined by the interests of the patients and the improved service which we want to provide.

Will my hon. and learned Friend maintain the greatest possible pressure to achieve accountability in the family practitioner service? Does he agree that every time family practitioners overrun what might be called projected expenditure the rest of the Health Service, such as the hospital sector, suffers and we experience problems of the kind facing us today?

With respect to my hon. Friend, that is not so, although some people interpreted the changes in July in that way. What happened in July was that cash limits for all programmes, not just the Health Service, were reduced to bring planned public spending within previously agreed levels. Part of the reason was that at the same time non-cash limited programmes were running ahead of the budgetary estimates. That included the family practitioner services.

Will the Minister come to the assistance of those committees that run deputising services and tell them exactly what he means by "excessive" use? Why is he now so pessimistic about deputising services, compared with when he spoke in Committee in March of this year on health services?

I hope shortly to come forward with our proposals for improving the monitoring of the deputising services. I find it difficult to divine the hon. Gentleman's views from his question, but there is widespread public and parliamentary concern about the way in which the present guidelines are being applied. I believe that there is general acceptance in the medical profession that there is some room for tightening up the deputising services.

My hon. and learned Friend will be aware that much of the administration of family practitioner services involves routine clerical work and that progress towards computerising patient records has been painfully slow. Will he undertake to speed up that process, because that would have a beneficial effect on expenditure on administration in the family practitioner services?

We have engaged the consultants Arthur Andersen and Co. as advisors on improving methods of administering all the family practitioner services. We have asked the consultants to look especially at the way in which we can speed up the application of computerisation and modern office techniques. I take my hon. Friend's point. It is important that we act promptly once the report from Arthur Andersen and Co. is at hand.

On what grounds does the Secretary of State justify arrogating to himself in the Health and Social Security Bill the right to appoint all the members of each of the 90 family practitioner committees? Is he not content with sacking all the non-compliant chairmen of the regional and district health authorities and packing the membership of those bodies with his own placemen? Is it not a monstrous perversion of patronage that he should reserve to himself the power to hand-pick all of those 2,700 appointees so that he can steamroller through his policies and blot out further resistance?

The hon. Gentleman has as ready a source of adjectives as of bogus statistics, but he is getting overexcited about a fairly simple change. The Secretary of State must represent the public interest and cannot just accept nominees. It is important that the family practitioner committees, which dispose of enormous sums of money, should be answerable to the House, amongst other places, through my right hon. Friend the Secretary of State.

asked the Secretary of State for Social Services if he will estimate the savings to the National Health Service which have resulted from the reduction in injuries since the wearing of seat belts was made compulsory.

We do not yet have the information needed for a reliable estimate, but I welcome the reduction in deaths and serious injuries which my hon. Friend the Minister of State, Department of Transport, reported in her reply to my hon. Friend the Member for Harlow (Mr. Hayes) on 5 December.

Do not the trends that the Under-Secretary has given show the importance of the Government spending money on the prevention of disease and injury, as that affects the National Health Service? In those circumstances, is it not unfortunate that, because of the many cuts in the Health Service, including those in my area of Waltham Forest, there is a serious danger of a disproportionate and adverse effect on the preventive services?

I do not accept that. We have shown our interest in prevention by, for example, increasing the sums of money made available to the Health Education Council. It is not doubted that the introduction of seat belt legislation has led to a reduction in deaths and injuries. We shall not know most of the full picture until next summer when we shall have the results of a report headed by the distinguished consultant, Mr. W. H. Rutherford of the Royal Victoria hospital, Belfast, which will bring together the experiences of 15 different accident and emergency services in the year before and the year after the introduction of the legislation.

Are the Government taking any action on the other half of the problem—the continued fitting in new cars of toughened rather than laminated windscreens, which is what people's heads go through if they come out of their seat belts? Or is that being left entirely to the Department of Transport?

That is indeed a matter for my right hon. Friend the Secretary of State for Transport.

Although the trend in the figures is encouraging, does the Minister agree that there is still a need for publicity to reinforce the law, especially in relation to the all too frequent practice of front seat passengers wearing seat belts but carrying small children or babies who are not protected?

The hon. Gentleman is absolutely correct, although it is heartening to note from police reports that between 95 and 96 per cent. of all front seat passengers wear seat belts regularly.

asked the Secretary of State for Social Services what percentage of the gross domestic product was spent on the National Health Service in the most recent year for which figures are available; and how this compares with the percentage in 1978.

The most recent year for which figures are available is 1982, when 5·4 per cent. of the United Kingdom gross domestic product was spent on the National Health Service. That compares with 4·8 per cent. in 1978.

Does my right hon. Friend agree that those figures show clearly the higher priority given to the National Health Service by the Conservatives than by the Labour Government?

Yes, they show exactly that. They show that we are spending more on the National Health Service than any other Government in history, and also treating more patients.

How does the Secretary of State reconcile the success stories with which he continually regales the House with the facts that we all know from our own areas? Is he aware that the North-West Thames health authority is seeking fully or partially to close 30 hospitals, including the House of Commons hospital—Westminster hospital? Is he further aware that £1·2 million allocated to the Central Middlesex hospital in my area nine months ago has been stopped, with the result that the hospital is now taking only emergency cases for acute beds? How does the Minister reconcile the success that he claims with the terrible impact of his cuts on patient care?

Any closure proposals by the North-West Thames authority would have to come to Ministers. Nothing in any strategic document could possibly alter that. As for the figures, I am sure that the hon. Gentleman, with his customary fairness, will acknowledge that the Government have increased spending on the Health Service and that spending is now 17 per cent. higher than the level that we inherited in 1978–79.

I welcome the increased spending on the Health Service, but does my right hon. Friend agree that the benefit would be greater if more hospitals followed the example of the Hinchingbrooke hospital, which serves my constituents, in privatising cleaning services, thus saving £200,000 per year, which can then be spent on essential medical services?

As I said in answer to an earlier question, we favour the policy of contracting out and competitive tendering because we believe that it will make the Health Service more effective.

Does the Secretary of State accept that health spending has increased as a proportion of GDP because GDP itself has decreased? Does he agree that health spending in this country still represents a lower proportion of GDP than in most other developed countries and that, despite all the Government's statistical waffle, throughout the entire country — including the areas represented by Ministers—hospitals and wards are being closed, new hospitals are left empty and nurses and doctors are unemployed?

The hon. Gentleman's assumption about GDP is just plain wrong. Between 1978 and 1982 GDP rose by 0·4 per cent. while the NHS share rose by 0·6 per cent. Health spending by virtually all European countries is between 5 and 6 per cent. of public spending. The proportion of GDP is increased by private spending on health in those countries. I thought that the hon. Gentleman was foremost among the opponents of private health spending.

asked the Secretary of State for Social Services whether he will now make a statement on the level of death grant.

I shall make a statement as soon as possible.

Is the Minister aware that his answer will condemn thousands of elderly people who are worried about burial costs to yet another Christmas of apprehension? Is it not a disgrace that the period for consultation on the Government's document ended 18 months ago, in July 1982? When may we expect an answer to the representations that have been made?

The hon. Member will get an answer as soon as possible. It is important to get a scheme whereby the money that is available — because vast sums of additional money are not available—can be used to help the families that need it to cover their funeral expenses.

Can my hon. Friend confirm, before the statement is made, that the Government are at least considering moving in the direction often recommended whereby, in return for those of us who do not need the £30 death grant sacrificing it, we have a rising scale payable on the basis of need?

I am very grateful to my hon. Friend. The suggestions that were put up some 18 months ago were exactly along the lines referred to by my hon. Friend—a grant of £250, £200 or £150 to people on supplementary benefit, FIS or war pensioners. It is from something along those lines that the solution is likely to come.

Will the Minister renew the pledge of his predecessor and seek the agreement of the Opposition before introducing any change to the benefit?

I was not aware that my predecessor made that pledge, but if he did, that pledge will be fulfilled.

asked the Secretary of State for Social Services when he expects the system of general managers at authority and unit level recommended in the Griffiths report to be established.

I have written to Health Service chairmen asking for views by 9 January on the implementation of this and other recommendations. I will issue guidance to authorities when I have considered their response.

Is my right hon. Friend aware of the anxiety about the lessening degree of managerial efficiency in the Health Service, as is very well evidenced in the pamphlet produced by my hon. Friend the Member for Norfolk, North (Mr. Howell)? Will he ensure that steps are taken as soon as possible to increase efficiency so that resources in the Health Service are used where they are most needed?

I must confess that I do not agree with all the suggestions put forward in the pamphlet to which my hon. Friend refers. However, where we clearly do agree is that the management process in the Health Service must be improved, and that is what the Griffiths report is all about.

Where does the right hon. Gentleman expect this new layer of management to come from? Will it be from the hospital administrators, who are already receiving redundancy pay?

The hon. Lady is wrong. It is not a new layer of management. The people who will become the general managers at district or regional level will probably be drawn in the main from the officers who are already employed.

asked the Secretary of State for Social Services whether he has any targets for productivity in the National Health Service.

Increases in productivity, to make the most of past and planned increases in resources, are a central part of Government policy towards the NHS. We have not set a national target figure, but specific objectives for individual authorities are set through annual accountability reviews. Those agreed by Ministers with regional health authorities are recorded in the regional action plans, of which copies are placed in the Library of the House.

Can my hon. and learned Friend explain why it is that, at a time of large increases in productivity within the wealth-producing sector of the economy, the number of people employed by the Health Service over the past 20 years has gone up by 750,000 and the number of people required to service one hospital bed has trebled? Can my hon. and learned Friend say what the Government will do, and do urgently, to stop the country from sweeping money into a hole in the ground known as the Health Service?

With respect to my hon. Friend, the Health Service is a person-to-person service, so that when one improves the service one inevitably increases the numbers of some employees. It is also the case that we look not at staff per bed but at staff per patient. As we increase the use to which beds are put, more patients are treated by fewer staff even though this is not reflected in the number of beds. Having said that, I accept my hon. Friend's point that much more could be done to improve the efficiency with which manpower is used in the National Health Service. Our first modest steps towards this end attracted some controversy earlier this year, but I think it is essential that we press on in that direction if the patient is to get the full benefit from the extra resources the Government are putting in.

asked the Secretary of State for Social Services whether he will now reduce the costs of National Health Service recruitment advertising.

We are currently considering the report of a Rayner style scrutiny of NHS recruitment advertising, which suggests various possibilities for reducing expenditure.

Is my hon. Friend aware that a recent edition of the Nursing Times contained more than 56 pages of NHS advertising for 500 or 600 vacancies? Is there not a cheaper way of circulating these vacancies than providing a public subsidy for a commercial paper?

Health authorities subsidise some of these journals to the tune of £7 million a year. That sum must be scrutinised closely to make sure that we are getting the best value for money, and that is what we are doing.

the Secretary of State for Social Services if he will make improvements to the working of deputising services; and if he will make a statement.

Deputising services are not part of the NHS and family doctors may employ their services only with the consent of the family practitioner committee, which is advised on the professional and ethical aspects of services by professional advisory committees. I am considering ways of strengthening existing arrangements and shall shortly be issuing revised guidance for consultation.

Will my hon. and learned Friend indicate what response he received to his letter of July to family practitioner committees? Has he extended those consultations to community health councils?

The response to my letter to family practitioner committees confirmed the response from members of the public and hon. Members of this House and satisfied us that something needed to be done to improve the monitoring procedures and to re-write and improve the guidance. I hope to make an announcement shortly. We have included community health councils, and they too have urged on us the need to improve present arrangements.

On a point of order, Mr. Speaker.

I will take the hon. Gentleman's point of order now because he has alerted me to the fact that it is highly urgent. I shall allow injury time for Prime Minister's Questions.

My point of order is vitally important to every hon. Member of the House, Mr. Speaker, and I am not raising a political issue. We are informed by the annunciator that the Secretary of State for Trade and Industry will make a statement this afternoon on the Government's regional economic policy.

The hon. Member has been here long enough to know that statements by Ministers are never circulated to Back Benchers.

Why not?

I am talking about the White Paper, Mr. Speaker. Why is that not available?

Order. Why not is not a matter for me. Statements are not circulated. I understand that they go to the Front Bench spokesmen concerned but not to Back Benchers.

asked the Prime Minister if she will list her official engagements for Tuesday 13 December.

This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today. This evening I hope to have an audience of Her Majesty the Queen.

Does not the news that the NGA is to picket again at Warrington challenge the whole basis of our democratic values? Surely all of us in this House have the right and duty to protect employees' decisions as to whether they should join a closed shop. If we do not do that we shall see our democracy undermined.

I am not quite certain whether the NGA has decided to picket again, but I wholly agree with my hon. Friend that the employees at the Warrington Messenger Group have exercised their right by ballot to reject a closed shop. They must be protected in the exercise of that right, and this dispute is about the NGA attempting to intimidate them to make them, nevertheless, join a closed shop. That is totally and utterly wrong and the law must be seen to protect those employees.

Will the Prime Minister now welcome the decision of the NGA to suspend its strike? Will she use the pause that that has now made available to exercise her powers to bring the various parties together to produce a settlement? Will she, for instance, ask ACAS to convene a committee of inquiry?

No. ACAS was set up by the Labour Government. It is there to conciliate. That is its job and it is not for the Government to intervene.

Does not the Prime Minister recognise that if others such as ACAS are effectively prohibited from exercising their function of conciliation by the straitjacket legislation that lies at the source of this conflict, she has a direct and absolute responsibility to accept that the buck stops with her? She should exercise her power. If she will not do so, will she give way to allow others to get power so that they can fulfil that responsibility?

The right hon. Gentleman makes it clear that what the Opposition really want is for the Government to force Mr. Shah to give in to the union's unreasonable demands. That we shall not do. On the Government side we shall uphold the right of employees to reject a closed shop—a right given to them by the law.

What the Opposition want is the resolution of a dispute that has been turned by Government legislation from a local problem into an industrial volcano. That is the direct responsibility of the Government. The Opposition and the country want the Government to fulfil their responsibilities to end this dispute now.

What I believe the people want, and what I believe they voted for, is for the law to uphold the right of employees to reject a closed shop. Does the right hon. Gentleman condemn the NGA for contravening the law? Will he uphold the right of the individual to reject the closed shop?

rose——

Order. The Leader of the Opposition has had three opportunities to put his case.

May I have your indulgence, Mr. Speaker? I am fed up with a Prime Minister who has power trying to dodge it by trying to award obligations to me — dodging all the time. I have no intention of condoning breaks of the law and no intention of being a drill sergeant for divisive and ruinous Tory legislation, either.

Will the right hon. Gentleman condemn intimidation of employees and companies?

The right hon. Lady should do the job for which she is paid.

Will he wholly and utterly condemn it and therefore uphold their rights to reject the closed shop?

asked the Prime Minister if she will list her official engagements for Tuesday 13 December.

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

Will the Prime Minister undertake to read last week's report by an anonymous group of Welsh HMIs entitled "Home School Links"? If she considers that this report is fatuous, complacent, lacking in substantiated detail and academic rigour, and that it fails to give any guidance to parents on the crucial issues of glue sniffing, under-age drinking and smoking, will she ensure that in future these HMIs are more suitably and sensibly employed?

I believe that Her Majesty's inspectorate does a very good job and that its work is almost universally welcome. The Government will be making a statement later on glue sniffing. We are watching the Scottish case carefully.

Is my right hon. Friend aware of the report in today's newspapers that the Government propose to send a British astronaut into space? Will she confirm or deny that?

I know nothing about such a report. It is not true, but there are certain hon. and right hon. Gentlemen whom I should not minding sending there.

Will the Prime Minister accept my sincerity when I say that I deprecate the events that led to the premature closure of a Brent council meeting last week? At the same time, will she consider those events less emotionally today? Is she aware that I attended that meeting and that there was no "Rentamob"? There were 300 people present, many of whom I have served as Member of Parliament for 24 years, and many of whom came from the local Methodist church, pensioners' associations and others. Will the Prime Minister accept also that it was an offensive break from democratic practices in an area where I canvassed for Mrs. Neil, because I was known and she was not? There have been 1,100 local voters, including Conservatives, who have asked Mrs. Neil to resign. The Prime Minister talked about gagging procedures last week, but the gagging procedures in Brent were no worse than when my hon. Friend the Member for Liverpool, West Derby (Mr. Wareing) had the payroll vote used against him in gagging procedures here.

It is strange that the power was not transferred peaceably from Labour to Tory-Liberal control. It was not. I do not know whether it was "Rentamob", but the reports were of a mob preventing the peaceful transfer.

Does my right hon. Friend agree that, despite Mr. Len Murray's advice, it is gross intimidation of innocent workers for Mr. Colin Barnet, the north-west region general secretary of the TUC, to promise that tomorrow's demonstration will be the largest that Warrington has ever seen?

I understand that there is to be a demonstration tomorrow, but that it will be away from the place of work. There is a right of peaceful demonstration. If there is a demonstration I trust that it will be peaceful. I am certain that the police will do everything to protect the right of ordinary workers to go about their ordinary business peacefully and without hindrance.

Will the Prime Minister give a general welcome to the report on Northern Ireland published this morning by the European Parliament by Mr. Haagerup? Will she pursue the suggestion that the Government have been considering, namely, a parliamentary forum in which Members of the House, the Northern Ireland Assembly and the Dail will discuss Northern Ireland problems?

The right hon. Gentleman will be aware that I take the view that the European Assembly has no business to discuss the internal political affairs of a member state. That is the view we took at the outset and to which we adhere, and to which I believe every state of the European Community must continue to adhere. An Anglo-Irish parliamentary body is a matter for the parliaments concerned and not for the Government.

asked the Prime Minister if she will list her official engagements for 13 December.

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

Will the Prime Minister reflect today—it is an appropriate time for her do do so—on the divided society that her Government have created. It is one in which the poor have become poorer, the rich have become richer, employee has been set against employer, and the sick are not recieving the attention that they could reasonably expect from a civilised society. Having done that, will she re-read the words from St. Francis which she uttered to the nation in 1979, and having read them, decide that it is time for her to go?

In reply to the hon. Gentleman may I point out that in the latest dispute it is the employees who are backing up the employer, not the other way round? With regard to many other aspects of society, we have over 60 per cent. owner-occupation—opportunities that would never have been given under Labour. With regard to the National Health Service, the amount spent on it each and every year has continued to increase. The Labour party in two years reduced the amount spent on the National Health Service. Further, the pension is at its highest ever level.

In the course of her busy day has my right hon. Friend had a chance to read further reports about the demonstration at RAF Greenham common on Sunday? Is she aware that 1,257 policemen had to be on duty that day from eight forces, that the cost of policing was £250,000, that 30 policemen sustained injuries and that 60 people were arrested? Despite the violence, and the huge cost of policing, which I hope my right hon. Friend will agree belongs perhaps more to a national charge than to a local one, is she aware that we in west Berkshire are determined that Greenham shall fulfil its role as a NATO defence establishment?

I am grateful to my hon. Friend. I think that the demonstration we witnessed there on television the other day will only have strengthened people's view that we must keep our defences in this country. We will not allow that kind of demonstration, far from peaceable, with many policemen injured, and, at one stage, barbed wire used to scar the side of a horse, to intimidate us. Indeed, it will strengthen us in standing for everything that we believe in, which is the upholding of the rule of law and freedom in this country.

Is the Prime Minister aware that many of my constituents have received no post for nearly two weeks, that they will probably receive no Christmas mail at all, let alone any serious and important letters such as pension books, business orders, hospital appointments and so on, largely because the Post Office has refused to accept arbitration from ACAS? Will she use her influence to get the Post Office to go to ACAS, as the trade union has agreed? Or is it the intention of her Government to underplay the role of ACAS so that she can continue her war against the trade unions?

There is a recognised procedure for conciliation. It is essential that that procedure is followed and the Government will not intervene.

Does my right hon. Friend agree that the action by the TUC leadership to discourage the National Graphical Association from proceeding with its strike is not only most welcome but shows a concern for NGA members which the NGA itself has not shown, and a respect for the law? Does she further agree that in this respect the TUC general secretary is setting an example which the Leader of the Opposition would do well to emulate?

I agree with my hon. Friend. The TUC believes in upholding the law. That is right in a democracy. The law is absolutely indivisible. People cannot choose which parts of it they uphold and which parts they flout. It must all be upheld. I believe the TUC has made that clear in the stand it has taken.

Will the Prime Minister find time today to study the words of Mr. McNamara on a television programme last Saturday night, when he said that there were no military justifications for cruise missiles, only political ones? In the light of this, will she now reconsider whether cruise missiles are necessary?

No. We watched the Soviet Union deploy many, many warheads, some 800 or 900 SS20 warheads. We asked the Soviet Union to take them down. We negotiated with it for nearly four years, asking it to take them down. In the absence of the Soviet Union going to zero option, we must put our own deterrent in place. We have done so and we shall continue with the programme of deploying cruise and Pershing missiles to protect the people of this country.