To ask the Secretary of State for Social Services what advice he has given to the four Thames regions regarding the specific services to be cut in order to meet their cash reduction over the next three years.

Before I answer the question, may I take this opportunity to express the regret of my right hon. Friend the Secretary of State at being unable to be here today because he is unwell?

I thank the Minister for his answer, but I fail to understand why, therefore, regional and district health authorities are all having to discuss how to meet the cuts that the Government are imposing. What does the Minister have to say about the findings of the medical committee of the South East Thames regional health authority that it is not unusual for breast surgery to be cancelled four or five times? What does he say to the terrified women whose lives may depend on swift and effective surgery and who are being treated in this disgraceful way so that Government financial guidelines can be met?

The Government have made clear their plans for the further development of breast cancer screening services and for ensuring that appropriate treatment is available. Additional moneys were made available to the Thames regions, under the heading of the so-called resource allocation working party bridging fund, last year. There will be further allocations under that heading in the allocations that are to be announced shortly.

Is my hon. Friend aware that, in the South East Thames region, the Lewisham and North Southwark district health authority has pioneered such innovations as cross-charging for out-of-district use and is selling services to the private sector and to other district health authorities? Will he consider encouraging authorities to extend the use of such market mechanisms in the context of a free NHS, to widen choice and improve services?

I shall certainly very much encourage all health authorities to examine such measures, which can assist in improving the services that we all want to be provided. The Lewisham and North Southwark district is also a good illustration of something else important—the massive capital investment taking place at Guy's.

Would the Minister be prepared, after Questions today, to meet a delegation of doctor and nurses from St. Thomas's hospital on the other side of the river, in which 137 beds have been closed? Is he aware that that hospital serves the needs of Members of the House of Commons—or at least those who have not made private arrangements?

As it happens, I discussed some of these problems last week at a meeting with a consultant from St. Thomas's, and I shall take into account what he said when considering some of the matters to which I have already referred.

Is my hon. Friend aware that, despite his welcome news about continuing increases in money for the regions, somehow or other in many districts—certainly in my region of North East Thames—there are still just as many difficulties as there ever were? Will he look again at the basis of allocation for the district health authorities?

We are reviewing what is called RAWP at the national level, and we are discussing with the regions the operation of their allocation policies at the sub-regional level. Of course, I shall take account of my hon. Friend's point.

To ask the Secretary of State for Social Services if he will make a statement on the state of supplies of flu vaccines within the National Health Service.

Vaccination for flu is a selective programme recommended only for at-risk groups. The number of doses given in recent winters has varied between 1·4 million and 1·6 million, but demand this winter appears, for extraneous reasons, to have increased to more than 2 million doses. That is 25 per cent. higher than normal. We expect some 2·2 million doses to have been delivered by next week.

Is the Minister aware that as long ago as early October constituents of mine were being turned away by their doctors, especially at the Royton health centre? They were told that no flu vaccine was available and that if they wished they could put down their names for next year. It is obvious from press reports in the last few days that this situation is widespread. Surely the Minister realises that this is preventive medicine at its best and that to have allowed flu vaccine supplies to dry up was a grave mistake.

I hope that the figures I have just given show that rather than flu vaccine supplies drying up, they have substantially increased this year. I understand that the scare stories running in the press resulted from a press conference held by an organisation called the Influenza Monitoring and Information Bureau which is run and funded by the three companies which produce the vaccine. We have no evidence whatever of any such epidemic or of any such scare having any basis in actuality.

To ask the Secretary of State for Social Services what reports he has received on the problem of retaining qualified medical laboratory scientific staff within the National Health Service; and if he will make a statement.

We are aware of reports of problems in some areas.

Does the Minister accept that medical laboratory scientific officers are highly qualified people and an integral and essential part of patient care? Does she agree that they are grossly underpaid and will she now agree to include them in the pay review body as soon as possible?

We do indeed regard them as very important people. The hon. Gentleman may not know that last week the staff side of committee A of the appropriate Whitley council accepted the offer of a 5 per cent, increase in pay and allowances, that this has been back dated to 1 April 1987, and payment of it is now in hand. However, we accept that there are problems with the present grading structure and we have commissioned an independent study covering the whole subject of the provision of pathology staff. We hope that the results of that study will shortly be available.

My hon. Friend will be aware that I wrote to her on this subject. I welcome her response to the grading study. Does she now accept that the laboratory staff have patient contact and that they are a vital link in the chain of medical care? We need to retain the most senior ones with experience, and the study should concentrate on them.

I hear what my hon. Friend says and thank him for his kind remarks. I understand that the difficulty is in retaining the basic grades, and therefore the study will pay a great deal of attention to that.

Will the Minister supplement the 5 per cent, salary increase with uniform payments? I am sure she will agree that that would reduce the high turnover and lift the morale of this vital but underpaid sector of the Health Service.

We shall take the hon. Gentleman's remarks into account.

Will my hon. Friend tell us how the number of scientific staff has increased during the lifetime of this Government? Is there any sign that the current salary levels have handicapped recruiting?

I have no details for all the scientific staffs of all types employed by the National Health Service, but I can tell my hon. Friend that the number of qualified medical laboratory scientific staff, which is the subject of this question, is now 11,000. That is an increase of 34 per cent, since 1979. The salary scales range from just under £7,000 for the lowest basic grade to over £17,000.

To ask the Secretary of State for Social Services if he will make a statement on the progress of community care programmes undertaken by district health authorities.

Considerable progress has been made in implementing Government policies on community care, although the rate obviously varies from place to place.

Does the Minister accept that there is much evidence that mentally handicapped people are simply being dumped on the community and are being given highly inadequate facilities and inadequate care? Will he give me an assurance that he will look sympathetically at village community schemes developed, for example, for Westwood hospital in my constituency rather than see hospitals close? Patients have been dumped on the community and the sites have been sold for private speculative development.

I do not accept the generalisation at the outset of the hon. Gentleman's question, but I certainly accept that some schemes have been better planned than others. Certainly the hon. Gentleman's suggestion about village schemes could be considered.

Will my hon. Friend confirm that it is not, and cannot be, Government policy that elderly or handicapped folk should just be sent home, and that it is essential to ensure that the necessary supportive welfare is in place before any old hospitals are closed?

Not only could it not and should it not be Government policy, but it is not Government policy. It is Government policy to ensure proper preparation of the sort that my hon. Friend rightly advocates.

Does the Minister accept that, for there to be a positive policy that facilities are available in the community, those facilities must include provisions such as domiciliary services for physiotherapy, speech therapy and so on? Does he accept that in practice that just does not happen in many areas, which means that the commitment to community care is a charade in those areas?

I agree that we would like to see a good deal more progress in various ways. The hon. Gentleman is well aware that we hope to make a further statement about primary care generally before too long. That statement will have some relevance to the points that he has raised.

Can my hon. Friend say when Sir Roy Griffiths is to report to the House on care in the community? Will he ensure that no psychiatric hospital or hospital for the mentally handicapped is closed before the report is published and the House has had a full opportunity to debate this critical issue?

We expect to receive Sir Roy's conclusions early in the new year. I do not think that I can give my hon. Friend the guarantee that he asked for in the latter part of his question. However, at our previous Question Time I gave him a guarantee that we would not agree to the closure of any hospital unless we were satisfied that proper alternative arrangements had been made.

Does the Minister accept that the assertions of my hon. Friend the Member for Bradford, South (Mr. Cryer) are supported by the Comptroller and Auditor General's report, in which Sir Gordon Downey commented most unfavourably on the Government's approach to community care and was particularly scathing about transitional funding arrangements? Does he accept that many hospitals are closing, not as a natural progression towards community care, but because they are in such a dreadful state of disrepair? Finally, whatever the hon. Gentleman says at the Dispatch Box today, does he agree that the Government's community care policies have been fatally and skilfully undermined by their approach to social security payments, which means that private homes are being subsidised to the hilt?

I do not accept either the last part of the hon. Gentleman's remarks or his suggestion that hospitals are being closed simply for reasons to do with buildings rather than patients. I readily accept that many areas of community care policy have been the subject of criticism. We accepted that those areas needed looking at, and that is precisely why we commissioned Sir Roy Griffith's work.

Does my hon. Friend accept that sufferers of schizophrenia require not just community care on discharge, but a gradation of community care? Will he please take that into account before closing hospitals and institutions and when advising local district authorities on the sort of care that they must have in place?

The question of psychiatric patients is particularly complex, and undoubtedly a range of care in the community is needed. In my judgment, it is being planned or provided in many places.

To ask the Secretary of State for Social Services how many claimants of housing benefit will receive lower benefit in April 1988.

Most housing benefit recipients also get at least one other social security benefit. Our tables show that, taking the income-related benefits together, some 3·65 million people will receive less benefit than if the old schemes had continued. In cash terms the number of losers is less than 1 million.

What will the Minister be telling pensioners whose Christmas bonus, pensions and savings will be eroded by an increase in rents in April? Will he spell out that it is his Department that is reducing housing benefit, rather than live in the hope that local authorities will take the blame for the cut?

I shall be telling pensioners that most of them will see a cash increase in housing benefit next April and that 70 per cent, of housing benefit losses will be under £2 a week.

Will my hon. Friend confirm that one of the reasons why the Government were elected was to end the "Why work?" syndrome and that the present arrangements for housing benefit are grossly unfair for the working poor?

The present arrangements have necessitated the very complicated housing benefit supplement, and that is lifted in the reforms. Altogether, the reforms will mean that more people will gain or experience no change than will lose.

Will the Minister accept that many people will experience tremendous hardship in Northern Ireland? Will he acknowledge that while £2 a week would not be a great loss to hon. Members, it will certainly be a loss to people at the lower end of the income scale?

The point that I want to make to the hon. Gentleman, and this applies as much to Northern Ireland as to Great Britain, is that as much money is going back into income-related benefits as is coming out of housing benefit. The figures balance each other out.

Will my hon. Friend accept that when we talk about Government money we are talking about taxpayers' money? Is it not right that a responsible Government should target help where it is most needed? That is what we are doing with the reform of the state welfare system.

My hon. Friend is absolutely right. The problem is to tell poor taxpayers with no savings that they should be making contributions to pay the housing benefit for people with more than £6,000 in the bank.

Will the Minister admit that his changes in housing benefit will remove all entitlement to housing benefit from 1 million current claimants and that most of the remainder will lose some, if not most, of their benefit? What kind of targeting leaves behind 6·5 million caualties from 7 million claimants?

I accept only the hon. Gentleman's point that 1 million people will lose housing benefit altogether. At the end of the reforms there will still be more people receiving housing benefit than there were under the previous Labour Government.

What proportion of households will receive housing benefit after April 1988? Does my hon. Friend believe that that proportion will be too high?

The proportion today is one third. That is made up of 7 million households, of which 1 million will lose eligibility to housing benefit, and therefore the future proportion will be somewhat under one third.

To ask the Secretary of State for Social Services what is his policy towards redundancy arrangements in the National Health Service in the light of the decision of the employment appeal tribunal in the case of Cato v Hammersmith and Queen Charlotte's special health authority that the authority unlawfully discriminated against Mrs. Cato.

The hon. Lady will be aware of the statement made on 28 October by my right hon. Friend the Secretary of State for Employment about the changes that the Government intend to make to statutory redundancy provisions, under which currently a woman cannot claim redundancy pay over the age of 60. The management side of the general Whitley council will shortly be reviewing present NHS redundancy arrangements.

I thank the Minister for her reply, and I am indeed aware of the announcement by the Secretary of State for Employment. Will the Minister tell us when the Whitley council arrangements will be announced? Does the Minister intend to back-date pay for women who have been illegally discriminated against, as they are now entitled to redundancy payment following the signing of the treaty of Rome?

The review that I mentioned will be conducted as quickly as possible. The hon. Lady is probably not aware that the current arrangements were introduced more than 20 years ago by a Labour Government headed by the present Lord Wilson. I have no intention of back-dating the changes to then.

Is the Minister aware that her right hon. Friend the Secretary of State for Employment, in spite of his statement, could have saved her and the DHSS some embarrassment if he had accepted a Labour amendment during the passage of the Sex Discrimination Act 1986 which would have prevented what is happening now? We should welcome the ending of discrimination in the National Health Service. Will the Minister make it her business—I know that she has the power to do so—to ensure that the Government extend the reform to the private sector as well?

The hon. Lady should be aware that the Government are steadily removing the discriminatory rules against women that were introduced by previous Labour Governments. We have done better for disabled housewives and for married women caring for the sick. I am not in the least embarrassed. I am pleased with the progress that is being made.

To ask the Secretary of State for Social Services how many families currently in receipt of family income supplement will receive an increase in benefit following the introduction of family credit.

Almost all families in receipt of family income supplement are expected to receive a cash increase when family credit is introduced.

Does my hon. Friend agree that these impressive figures are a vindication of the policy of concentrating resources on low-income families, rather than spreading them thinly through increases in child benefit, which benefit the better off most of all? Will he tell the House how many families will receive an increase of more than £5 a week when family credit is introduced?

I agree with my hon. Friend's comments. We shall be spending over £300 million extra on low-income families as we move to the new system of benefits, when 240,000 families will benefit by more than £5 a week.

Does my hon. Friend agree that this important benefit, which was first introduced by my noble Friend Lord Joseph, does much to remove families from the indignity of being better off out of work than they are in it? Does he agree that the particularly important modifications that he has introduced give greater recognition to the needs of teenage children, which is a matter on which the poverty lobby has campaigned for a long time?

I am sure that the benefit is a major improvement and will be of particular help in the sectors that my hon. Friend has identified. We want it to be available to as many people as possible after the changeover.

To ask the Secretary of State for Social Services how many children have been born suffering from AIDS in the last three years.

We have had no reports of any babies diagnosed with AIDS at birth. Since the beginning of 1985 there have been reports of 63 children born in the United Kingdom with antibodies to the human immunodeficiency virus. All were born to mothers who were either infected with HIV or at high risk of infection. We do not know in how many of those children the HIV antibodies will persist. There may also have been other babies with HIV who have not been tested and reported.

Is the Minister aware that the report of the Select Committee on Social Services goes into some detail about the fact that we do not yet know how AIDS is transmitted to babies, whether it be after birth or during pregnancy? The report makes many recommendations on how money should be spent and research carried out to discover the extent of the problem. When will the hon. Gentleman respond to the recommendations in the report?

We hope to respond to the Select Committee's recommendations quite shortly. I shall have in mind the points that the hon. Lady has made.

Does my hon. Friend accept that, grievous though the problem of the number of children born suffering from AIDS is, the problem of children born with heart defects is much more serious, as is highlighted by——

Order. The question is about AIDS.

To ask the Secretary of State for Social Services if he will detail the provisions he has made to ensure that social services departments who care for people with AIDS and their carers are properly equipped to fulfil this duty.

Social services departments have an important role to play in supporting people with AIDS. An additional £5 million was included in the rate support grant settlement for 1987–88 in recognition of the extra work for local authorities arising from the increase in drug misuse and AIDS. We are currently considering what extra help will be needed next year, particularly for the local authorities with the greatest case loads.

I thank my hon. Friend for that reply, but will he assure me on two points? First, is the money that was put aside reaching the social services departments? It often tends to get sidetracked. Secondly, social services departments that have so far not had large case loads of AIDS seem to be in danger of reinventing the wheel. Will he ensure that departments that have had a lot of experience are able to share it with those that do not

I must tell my hon. Friend that, as he is already aware, unless the Government attempt to dictate each and every aspect of local authority expenditure, the amount that is spent on social services depends on the decisions of local authorities. On the latter point, I am hopeful that the reports and co-ordination between different kinds of authorities that are entailed in the AIDS (Control) Act 1987 will contribute to his aim.

Is my hon. Friend aware that there are more cases of AIDS in north-west London, because of the hospital facilities and other facilities there to cope with them? Will he ensure that local authorities and health authorities have the resources that they need to cope with the problem, without penalising other vital services?

Of course, North-West Thames has about half the current AIDS cases in England. We have been making extra allocations to it accordingly. There will be further allocations to North-West Thames next year, which I hope to announce shortly. I have also had talks with some local authorities in the relevant parts of London in the hope of finding some way of making appropriate help available to them.

To ask the Secretary of State for Social Services how many people are in occupational pension schemes.

In 1983, which is the year covered by the Government Actuary's most recent survey, 11·1 million employees were members of occupational pension schemes.

I thank the Minister for his reply. Does he agree that, in spite of what Opposition Members say, the provisions of the Social Security Act 1986 will be welcomed by millions of people? Does he agree also that such provisions will give them greater independence and will amount to a social revolution that is on a par with the revolution that was caused by the sale of council houses in the first two Parliaments?

I totally agree with my hon. Friend. For some years the number of people in occupational pension schemes has remained stubbornly at about 50 per cent. The Act will widen flexibility, opportunity and choice in the provision of pensions.

Does the Minister accept that occupational pension beneficiaries are becoming angry at the amount of abatement in their occupational pensions when they have to retire early? It means that their pension approaches unemployment benefit rates. Many occupational pensioners have to retire early. Will the Minister examine the matter and give occupational pensioners much more generous treatment?

Unemployment pay is designed to insulate people against unexpected unemployment. It is not designed to top up occupational pension schemes. The Government were right to move in the direction in which they did.

Does my hon. Friend agree that the rapid development of occupational pension schemes is a most attractive feature of modern society, but they should go hand in hand with the future development of state retirement and old-age pension systems and not be a replacement therefor?

I am sure that the state retirement pension should be a basic provision. The more that people can look to the provision that they are able to make, either through personal or occupational pension schemes, the better they will be able to enjoy their retirement.

Does the Minister recognise that if people do as the hon. Member for Norfolk, North-West (Mr. Bellingham) said and welcome the passage of the 1986 Act, it can only be because they have not read what the Secretary of State has said about the way in which people who took out personal pensions will assume full responsibility for success or catastrophe in their pension arrangements? Does he further accept that, as my hon. Friend the Member for Falkirk, East (Mr. Ewing) said, the way in which the Government are continually eroding the rights of those with occupational pensions is particularly pointed? Does he acknowledge that, in effect, with the Social Security Act 1986, the Government are saying that the age of 55 is the age of retirement, but at one's own expense?

On the first point, the Financial Services Act 1986, when it comes into operation, will provide proper consumer protection for those who take out personal pensions. There will be an early opportunity in Committee to discuss the interaction between unemployment benefit and occupational pensions. We shall see who wins the argument.

To ask the Secretary of State for Social Services what proportion of the increases in the National Health Service budget announced by the Chancellor of the Exchequer for 1988–89 and 1989–90 in the Autumn Statement he intends to grant to the north-west region; and if he will make a statement.

Health authority allocations for 1988–89 will be announced shortly. Allocations for 1989–90 will be announced towards the end of next year. The North West regional health authority this year has taken 9·1 per cent, of the total allocated budget.

I am grateful to my hon. Friend for her response. On behalf of the people of the north-west, I give hearty thanks to her. On Friday the new children's ward at Wrightington hospital was opened for extremely sick children. Will my hon. Friend confirm that the second biggest allocation in the country is going to the north-west and that nine hospitals are under construction at the moment? Will she confirm that the 22 hospital projects that are planned for the next few years will be secure and that the people of the north-west can look forward to their new hospitals?

I thank my hon. Friend for his kind remarks. He knows that I took a personal interest in the children at Wrightington hospital. I am pleased to hear about the progress being made. My hon. Friend is absolutely right about the capital scheme. The sum of £73·4 million has been allocated to the north-west region this year. It is the second largest capital allocation in the country. It compares with £38 million in 1978 under the Labour Government, of which various Opposition Members were members. Of the nine schemes under construction, there are major schemes in Oldham, Tameside and the Manchester royal infirmary, for which my hon. Friend the Under-Secretary laid the foundation stone last year. I shall take my hon. Friend's other remarks into account.

Some time ago I wrote to the Minister about the cuts in budget in the Wigan health authority area, where the cervical cytology scheme is £30,000 short. She refused to meet me and other hon. Members on this question. Will she reconsider the matter, as the health authority is now doing what the Government asked it to do in relation to the scheme?

I am delighted to hear that the hon. Gentleman is interested in cervical cytology. The Government are determined to cut the death toll from this appalling cancer affecting women. I am satisfied that all our health authorities will have the appropriate computerised call and recall systems in place by next year.

In making allocations to the north-west, will my hon. Friend take into account the fact that places such as Lancaster have substantial aging populations? While we are very happy to take responsibility for this natural phenomenon, matters are complicated by the enormous influx of people from places such as Blackburn. That puts a very considerable strain on our resources. Will my hon. Friend take that into account in her allocations?

I am glad to report to the House that in the Lancaster health authority area we do, indeed, take into account the pattern of demography. From 1982 until now patient activity has increased on all fronts. In-patient cases treated are up by 12·5 per cent., out-patient attendances have increased by 12·3 per cent, and a major redevelopment of the Royal Lancaster infirmary, costing nearly £16 million, is due to start shortly. My hon. Friend's remarks point to the reasons why we are giving extra money to Blackburn and the other health authorities in the north-west region.

To ask the Secretary of State for Social Services what representations he has received on the question of care in the community in the last month.

We continue to receive a considerable number of representations. Those received last month included the letter of the hon. Member for Workington (Mr. Campbell-Savours) of 6 October, to which I replied yesterday.

Is it not outrageous that Kent county council has ignored allegations made by Yorkshire Television about community care in Kent and the treatment of the elderly and mentally handicapped? Is it not significant that the Conservative-controlled Kent county council discussed those allegations behind closed doors and that it has taken no action at all, despite repeated representations by Labour councillors about the fact that criminal elements own homes in Kent and are licensed by the local authority? Will the Minister intervene now, or do we have to see heartless Thatcherism at its very worst persist?

I am disappointed that the hon. Member is not in the least interested in the excellent developments in this field in Workington. He has asked me about Kent. He should be aware that Kent county council has not only taken immediate action, but had taken action before the television company got round to making its programme. The council is fulfilling its statutory obligations in the way that we would expect of it.

Is my hon. Friend aware that Kent has one of the most innovative community care and residential care programmes in the country and that, as she hinted, a great many of the defects to which the programme drew attention had already been rectified before the programme went out?

My hon. Friend is quite right to be very angry at the stupid remarks made by the hon. Member for Workington.

Is the Minister aware that the financing of community care is hopelessly muddled between hospitals, local authorities and her Department? Until that is clarified and far more money is provided for community care, it will remain more of a slogan than a reality.

The right hon. Gentleman will remember that I was a member of the Select Committee which reported on community care a little while ago. That Committee said very much the same sort of thing. That is why my right hon. Friend the Secretary of State last year asked Sir Roy Griffiths to report to us on the pattern of financing and how it might assist us to promote further that important policy.

Has my hon. Friend received representations directly on the worrying number of cases of individuals with mental illness or mental handicap, particularly those with behavioural problems, who are being passed to and fro between the social services and local authorities, very much to their disadvantage? The buck is being passed to and fro. Has my hon. Friend received those representations herself?

The appropriate care and treatment of mentally ill people, particularly those who are voluntary patients, is extremely difficult. I am aware that the number of mental illness units in the Health Service in general hospitals has increased and the number of in-patients has decreased, which has enabled our staff to look after them much better.

Does the Minister agree that the onus for care is now falling on voluntary bodies and that those bodies have no budgets to deal with it? The carers association in Southport receives a grant of only £50.

I am sure that the hon. Gentleman can make the appropriate representations to the authorities in Southport on that.

Bearing in mind the problems faced by the families of those who are mentally ill, even in areas such as Norfolk, where the community care programme is going quite well, does my hon. Friend agree that attention needs to be paid to the rate of closure of the larger mental hospitals, as outlined by the Select Committee, which was referred to a moment ago, and by the early-day motions on the Order Paper at present?

Yes, I share my hon. Friend's concerns. The care in the community initiative is neither a cheap option nor an exercise to achieve indiscriminate hospital closures. We look to Sir Roy Griffiths to advise us shortly on how we may proceed.

To ask the Secretary of State for Social Services what representations he has received concerning actions taken by health authorities to balance their 1987–88 revenue budgets.

Representations have been received from a number of right hon. and hon. Members including the hon. Member for Burnley (Mr. Pike).

What does the Minister intend to do to enable health authorities to meet the demands of the community and avoid making cuts in patient care, as they are being forced to do throughout the country? For example, in Burnley there is the closure of the Victoria hospital, which the local authority claims is a temporary closure, but it will be permanent, thus avoiding the consultation procedure.

I am somewhat surprised at the hon. Gentleman raising that point. He knows that the background to the proposals concerning the Victoria hospital in Burnley is the recent opening of a major extension costing £6 million providing the facilities at the Burnley general hospital.

Is my hon. Friend aware that a regional audit team was recently put into my district health authority, where there is currently a shortfall of some £200,000, which will rise to a shortfall of £500,000 by the end of the year? Is my hon. Friend aware that cost-cutting reductions are being asked for across the entire northern region, but that there are other district health authorities within the northern region which are not being asked to make the same reductions? Will he join me in pressing the regional health authority to put the audit team into every other district health authority so that proper cost-cutting reductions can be made everywhere?

What I will continue to do, and have done on previous occasions, is to encourage regional health authorities to work together with district health authorities to tackle some of the problems. In my view the use of audit teams to look at the scope for savings and to contribute to the maintenance of services is a sensible part of those arrangements.

Is the Minister aware that the real cuts that have taken place in health authority budgets have led in recent days to repeated cancellations of heart operations for babies as young as 11 weeks old in Coventry? Is he further aware that we learnt just over an hour ago that the parents of six-week-old David Barber, constituents of my hon. Friend the Member for Newcastle-under-Lyme (Mrs. Golding), were refused permission in the High Court for an injunction to compel the Birmingham health authority immediately to carry out a life-saving operation on that baby? If there are any deaths because of cancelled heart operations, the Minister, his team and the Prime Minister will not be able to pass them off as accidents—it will be murder.

As the hon. Gentleman knows, the principal problem in these cases has been a shortage of intensive care nurses. I understand from the chairman of the West Midlands regional health authority, to whom I spoke this morning, that there has been some improvement in the staffing position, as a result of the return of some staff from illness, and that all the intensive care beds there are now open. I am hopeful that this will help, although I recognise that the clinicians must decide the order in which patients are treated, according to the urgency of their case.

To ask the Prime Minister if she will list her official engagements for Tuesday 24 November.

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.

Is my right hon. Friend aware of the decision taken yesterday by the North East Thames regional health authority to build a new cancer treatment unit at Harold Wood on the eastern outskirts of London and to close the cancer treatment unit in Southend, which will mean a very long journey for my constituents and those of my right hon. and hon. Friends in the area? Will she prevail upon my right hon. Friend the Secretary of State for Social Services to review this decision, to spend some of the money at Southend and to keep open this cost-effective unit, which gives dedicated care to thousands of cancer sufferers every year?

I am aware of the decision of that regional health authority. As my hon. Friend knows, the matter will now come to my right hon. Friend the Secretary of State, who will look carefully at the authority's proposals, and his prime concern will be to ensure the best interests of the patients. My right hon. Friend will take into account the Department's own review of the basis on which radiotherapy services are provided.

Will the Prime Minister tell us precisely what is the justification for making nurses in residential homes liable for the whole of the poll tax?

Nurses in residential homes will have the same treatment on community charges as other people. Of course, if their incomes are low, they will be able to get up to 80 per cent, rebate on the community charge.

Is the Prime Minister making a new announcement that low wages, such as those of nurses, will be enough to qualify people for the full 80 per cent, reduction in poll tax liability?

No. What I am saying—as the right hon. Gentleman is aware—is that student nurses receive more than those at universities who receive student grants. That is the reason for the difference. I note that the right hon. Gentleman tries to masquerade as being on the side of the nurses—[Interruption.] The Opposition can hardly claim to be the nurses' friend. They cut nurses' pay in real terms for three years running, and in 1976–77 by 10 per cent. In the five pay years between 1974–75 and 1978–79 they cut nurses' pay in real terms in four of those years. Under this Government the pay of nurses has gone up by 30 per cent, in real terms.

If the Prime Minister is concerned now about the economic position of nurses, will she instruct the Secretary of State for Social Services not to withdraw the special night-time and weekend payments from nurses, and will she instruct the Secretary of State for the Environment not to impose the poll tax obligation on people who currently have little or no rates obligation?

No, Mr. Speaker. The proposals go to the review body for nurses' pay, which was granted by this Government and which nurses did not have under previous Governments. It is necessary to consider the pay of nurses structurally. One thing which arose on a question to which I heard the answer given a moment ago is that nurses who serve geriatric patients are given higher pay than those who serve in paediatric units. That is causing problems. Yes, the pay needs to be looked at structurally, and the review body is the right body to do it.

In view of the repugnance felt in all parts of the House about the horrific atrocities committed by the IRA, will my right hon. Friend seek a meeting with the Leader of the Opposition on Privy Councillor terms in order to ensure that the Opposition withdraw all support from the hon. Member for Brent, East (Mr. Livingstone)? [Interruption.]

Order. It is perfectly in order for the Prime Minister to answer the question whether she will have a meeting.

No, Sir. I will not seek a meeting with the Leader of the Opposition. I think that most of us believe that no one in this House should have contacts with the IRA or Sinn Fein.

To ask the Prime Minister if she will list her official engagements for Tuesday 24 November.

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

Will the Prime Minister tell the House why she is so opposed to the televising of proceedings in the House of Commons?

Suppose we wait until the debate. I do not think that televising the House would enhance its reputation.

To ask the Prime Minister if she has any plans to seek to pay an official visit to New Zealand.

I have at present no plans to visit New Zealand.

Will my right hon. Friend perhaps reconsider her decision? The New Zealand Government are Socialist, but they are at least following my right hon. Friend's economic policies and cutting higher taxation as well.

I note what my hon. Friend says. I know that New Zealand is following Thatcherite economic policies in removing exchange controls, selling shares in a number of Government-owned enterprises and reducing the burden of taxation and Government expenditure as a proportion of output. I agree with those policies. It only goes to show that the Labour party is out of step, not only with the mood of the country as a whole, but with its brothers abroad.

Will the Prime Minister take a lesson from the Government of New Zealand and learn that it is possible for a Western democracy to have a foreign policy which is not one of total subservience to the United States?

I believe that if a country relies on another country to help with its defence it should give that country's ships refuge in its harbours.

To ask the Prime Minister if she will list her official engagements for Tuesday 24 November.

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

Does my right hon. Friend recall that last month she received a telegram from the newly formed Moscow branch of the International Society for Human Rights, the release of whose leaders, Alexander Ognorodnikov and Vallry Sendlrov, many right hon. and hon. Members on both sides of the House campaigned for in recent years, and who are now resuming monitoring of the Helsinki Final Act? Does my right hon. Friend agree that the existence of such groups without discrimination, harassment and persecution will be the shrewd test of glasnost and the end of the Stalin terror?

Yes, Mr. Speaker, I recall that telegram. I agree with my hon. Friend that the right of such groups to operate freely, which was guaranteed by the Helsinki accords, will be one of the tests of openness and democracy in the Soviet Union. But it is encouraging that two of the founders of the group, whom my hon. Friend mentioned, both with a long record of human campaigning, were released from prison earlier this year.

The Prime Minister will be well aware that in the run-up to the Ministers' conference on pollution in the North sea there has been much criticism from nations traditionally friendly towards us, not only of the extent to which Britain is responsible for pollution of the sea, but of the degree to which we have been feet-dragging in coming to agreements to do something about it. Is the Prime Minister concerned about Britain being known as a bad neighbour? If so, what initiatives will Britain be taking this week to clean up the North sea and this country's image?

We are delighted to be hosting the second international conference on the protection of the North sea. The United Kingdom is committed to a clean North sea, and is therefore ready to play its part. The majority of pollution input to the North sea is via rivers, and with £200 million of expenditure on improvement, I am pleased to say that the Thames is just about the cleanest metropolitan river in Europe.

During her busy day, will my right hon. Friend consider the claims that Vanessa Redgrave and two other members of the CND funded the operation to spring George Blake from Wormwood Scrubs? Bearing in mind that at a recent press conference Miss Redgrave appeared to admit to that serious crime, should not Miss Redgrave, Mr. Pottle and Mr. Randle be charged?

As the House knows, charging people for a crime is not a matter for me but for the prosecuting authorities.

Will the Prime Minister explain to the House how she equates her view that there should be no negotiations with the IRA with her membership of a previous Conservative Government in which Lord Whitelaw actually met and negotiated with the IRA? Can she assure us that there have been no further contacts between the IRA and members of her intelligence services, MI5 and MI6, during the last eight years?

Ever since 1979 the policy of the Government has been that we have no contact at ministerial level with the IRA or with other terrorist organisations. They are working fundamentally against the citizens of this country, fundamentally against democracy and against all innocent people in this country and in the Republic of Ireland.

Does my right hon. Friend agree that if criminals carry weapons and firearms and are prepared to use them, they must expect to meet that sort of force exercised on behalf of our society?

If there were not terrorism it would be easier to tackle these matters, but the police and the security forces who operate on our behalf must have full means for proper self-defence.

To ask the Prime Minister if she will list her official engagements for Tuesday 24 November.

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

In the light of the previous exchange between the hon. Member for Coventry, South-East (Mr. Nellist) and the Minister for Health about open-heart surgery, will the Prime Minister ensure that the Government take action today on the case of David Barber, who has had his operation put off five times? Will she ensure that immediate action is taken so that the operation takes place and his life is saved, or is her only intention to attend the funeral?

I heard my hon. Friend say from the Dispatch Box that the unit of the Birmingham hospital is today back to full strength. It is hoped that the operation will now take place as soon as possible. My hon. Friend also explained that previously there was a shortage of peadiatric nurses—[HON. MEMBERS: "Why?"] I have indicated, in answer to a previous question, that that was one reason why we need to look at the pay of nurses structurally, to see that such shortages are remedied.

As the Prime Minister's responsibilities include the security of the nation, will my right hon. Friend consider whether the advice of Arthur Scargill that members of the Communist party should be able openly to join the Labour party——

Order. That is not within the Prime Minister's responsibilities.

To ask the Prime Minister if she will list her official engagements for Tuesday 24 November.

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

As a mother, would the Prime Minister be happy with a Government who create conditions in which a small baby has to apply for a life-saving heart operation six times, but has still not yet had it?

As I have stated earlier, there have been enormous increases in expenditure on the Health Service. Birmingham was short of paediatric nurses, but we are trying to deal with that problem by looking at the pay of nurses on the basis of the areas in which we need more nurses. I understand that the unit is now back to full strength and that it is hoped that the operation will take place soon.

To ask the Prime Minister if she will list her official engagements for Tuesday 24 November.

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

Has my right hon. Friend had time to consider the current proposal of the EEC that British summer time should end in September instead of October? Bearing in mind that most people object to its ending in October, will my right hon. Friend tell her colleagues in the EEC when she next meets them that it is yet another of their daft proposals and that we do not want anything to do with it?

I understand that a draft directive has now been proposed that extends the existing arrangements for a further year. It would have the effect of maintaining the status quo in all countries until the end of 1989, so that we shall have time to consider whether it is advisable that we take on a similar date to Europe.