To ask the Secretary of State for Health what plans he has to cash-limit general practice; and if he will make a statement.

My objective is to achieve a good quality service for patients and value for money in general practice, as in the rest of the National Health Service. My hon. Friend may wish to await our proposals for the whole of the NHS which will be published shortly.

As I am sure that my right hon. and learned Friend appreciates the importance of general practitioners giving value for money to the patient and the taxpayer, will he take into account that they also act as a helpful safeguard—a safety valve—for a cash-limited hospital sector, which makes it important that there be the absolute minimum of Treasury interference?

General practice is the key to a great deal of the British Health Service's success. The general practitioner is the first person to whom a patient looks for advice for himself and his family. The general practitioner is the gatekeeper to the rest of the Health Service, deciding on referrals to the most suitable part of the service. I certainly accept the value of general practice and I am sure that our proposals, when published, will underline its crucial role and seek to support general practitioners in carrying it out.

How does the Secretary of State answer patients' justifiable fears that when general practitioners are kept to fixed budgets they will limit patient care so as to keep within the budget? Will not doctors give treatment to suit the budget rather than treatment that suits the patient, and what happens if the money runs out?

At the moment, I am telling people with hypothetical fears about hypothetical proposals that they should wait for our full proposals to be published, together with the supporting arguments, which I am sure will set the hon. Lady's fears at rest.

Does my right hon. and learned Friend agree that the low percentage of GDP that we spend on our excellent Health Service is a measure of the value that we receive from general practitioners and their cost-effectiveness in delivering health care? Can he assure me that after the review of the NHS the general practitioners will play a leading role in delivering services to their patients?

I agree with my hon. Friend's first point and I shall try to match up to his hopes on the second point. We have a pretty cost-effective service. One reason for that is the fact that general practitioners refer people, thus making the best use of the hospital service. I much prefer our system to that which prevail in other countries, where patients are expected to have individual specialists for whatever complaint they think that they have, and thus go to the part of the service that they judge best, without professional advice.

To ask the Secretary of State for Health what information he collects from district health authorities concerning the contracted hours of work of junior hospital doctors; and from what date such information has been collected.

Information has been collected each year since 1976 on the number of contracted hours of duty for each junior hospital doctor in England and Wales. Contracted hours comprise hours of work and hours on call. They fell from an average of 91·3 hours in 1976 to 85·7 hours in 1986.

In the light of the grave concerns that junior hospital doctors are expressing about their ability properly to carry out their role, what reassurance can the Minister give to patients that their lives and future are safe in those hands?

The hours that junior doctors work are determined by the heads of their clinical teams. A key part of the judgment of those who determine those hours is to ensure that the doctor carrying out the duties is capable of so doing. However, the Government are dissatisfied with the situation in which a significant minority of junior hospital doctors are expected to work and to be on call for far too many hours. Last June my predecessor asked each district to set up a working party, consisting largely of doctors, to eradicate any scheduling worse than one in three. We are in the middle of that exercise, but the evidence that we are receiving from the regional health authorities suggests that further reductions are being made as a result of that initiative. The working party is on course to report fully by the end of September.

Can my hon. and learned Friend confirm that not all specialties involve long hours for junior doctors in hospitals? Some are not really very bad. Secondly, is he aware that it has been put to me by professional concerns that because doctors' qualifications often depend on the hours worked in certain specialties, if the hours are shortened the time before qualification is likely to be much longer?

I am grateful to my hon. Friend for introducing into the debate certain points that have sometimes been missed. First, although junior doctors' hours are undoubtedly onerous throughout the service, it is a minority who work the hours that we all agree to be excessive. The last study carried out on the average number of hours worked in different specialties revealed that the average hours of work for a junior doctor in psychiatry were 46 hours per week, but in general surgery the figure rose to 67 hours per week, which is obviously very high. As my hon. Friend says, a key part of junior hospital doctors' training takes place on the ward, where they see difficult cases being treated. Plainly, any action taken to reduce the number of hours that junior doctors work must take into account the need for them to gain experience and to be capable when they become consultants—we hope that most will become consultants by their late thirties—of dealing with a wide range of problems.

Is the Minister aware that nowhere is it laid down that junior doctors must work so many hours continuously? I stress the word "continuously". We know about the average figures, but it is the word "continuous" in which I am interested. Continuous working must detract from performance. Is the Minister taking any steps to stop continuous working?

As the hon. Gentleman knows, we are in the middle of our initiative with a working party, consisting mainly of doctors, in each health district. We must see how that works out. The preliminary indications are that that is causing a reduction in the most onerous shifts in each region. The hon. Gentleman has made an interesting point about the number of hours that a person works, or during which he is on duty continuously, and whether that should be regulated. That is one of the matters that we have in our minds at present.

Does my hon. and learned Friend agree that the word "average" is a little suspicious because it implies that many people are working a good deal more than the average as well as the fact that others are working a good deal less? Does he agree that many constituents are complaining that some of the doctors have established their case? I hope that he will proceed with all vigour to do something about this. I should like to draw attention to an article in The Evening Standard—

Order. This is Question Time.

The last time that a major sustained effort was made to reduce the extremely onerous shift patterns of some junior doctors was in 1982 and it resulted in a 30 per cent. reduction in extreme shifts. We hope to achieve a similar result or even an enhanced rate of progress with the present initiative. My hon. Friend should be aware that some of the difficulties are structural. The NHS must offer 24-hour cover in every hospital unit throughout the land. Some of the ways in which junior doctors' hours could be cut—by rationalising services in each district on to one site, for example—would lead to equal concern among hon. Members if that meant that smaller hospital units had to be closed.

If the Minister is so dissatisfied with the excessive hours of junior hospital doctors, why do the Government propose to resist tomorrow the Bill introduced in another place to reduce those excessive hours to 72 per week, which many doctors still regard as excessive? How can it be right to limit the hours for which lorry drivers can drive and airline pilots can fly, but wrong to limit the hours during which junior doctors can carry out complex medical treatment? If the hon. and learned Gentleman expects the House to take seriously his commitment to reducing those excessive hours, will he assure the House that he will withdraw the circular that he issued only last November requiring junior doctors to cover for colleagues on sick leave and thus work even longer hours than at present?

The hon. Gentleman is seriously in error if he thinks it a legitimate criticism of Ministers that we should be taking steps to prevent the expansion of a system whereby the NHS is obliged to pay £900 per week for the services of locum doctors from private agencies. The hon. Gentleman should look for a golden thread of principle to run through his representations. It does not seem to be there in this instance.

To ask the Secretary of State for Health when he anticipates making a statement to the House on the National Health Service review.

To ask the Secretary of State for Health what representations he has received concerning the Government's review of the National Health Service.

To ask the Secretary of State for Health if he will include the abolition of the regional health authorities in his review of the National Health Service.

To ask the Secretary of State for Health if it is his intention to bring forward proposals to remove local authority representatives from district health authorities.

To ask the Secretary of State for Health what representations he has received regarding the working of the internal market of the National Health Service.

I shall be publishing a White Paper on Tuesday 31 January. I shall make a statement on that day.

Is the Secretary of State aware that Nottingham district health authority which covers my constituency of Nottingham, North, as well as his own constituency, meets on Thursday? Will that be the last ever meeting at which there is local authority representation on the health authority? Is the right hon. and learned Gentleman aware that the health authority is underfunded by £8 million, even on his own reckoning? Will he use the review to put that money back into the health authority or will the review be used to fiddle the figures and get rid of the RAWP formula?

Nottingham health authority, like all the others, is a statutory body and legislation would be required to change its composition or its powers. The hon. Gentleman quoted the figure of £8 million. That is the target for the spending set under the RAWP formula, and one to which the region is much nearer than it has ever been before. The target is not any measure of underfunding—the hon. Gentleman is misusing the figure when he quotes it in that way. It is a target towards which the Government have moved the health authority rapidly.

Does the Secretary of State appreciate that the National Health Service spends less of its budget on administration and bureaucracy than Marks and Spencer does? Is he committed to maintaining that level of efficiency? If so, will he give a categorical assurance that as a percentage of the National Health Service budget administrative and bureaucratic costs will not increase once the review proposals are implemented?

I am not responsible for Marks and Spencer, so I cannot make the instant comparison that the hon. Gentleman seeks to make. We need a non-bureaucratic and effective management system. Many of the figures bandied around about administrative costs of the National Health Service are not always what they appear because they tend to include only the staff costs of the health authorities which are, of course, just a small proportion of all the administration that goes on in hospitals and units throughout the country.

Does my right hon. and learned Friend accept that many people are concerned about the continuing high cost of bureaucracy in the Health Service and that many, if not all, of the powers currently exercised by the regional health authorities could be devolved to the district authorities if not to the hospitals? If the Department of the Environment can negotiate successfully with 400 local authorities, presumably my right hon. and learned Friend's Department can manage with fewer than 200 district authorities.

What we want is good quality decision-making and the right choice of priorities and that needs clear lines of management responsibility and accountability. We want good, effective management involving all the people in the Health Service and no bureaucratic systems at all. My hon. Friend will have to judge our proposals when he sees them in the White Paper. I agree with his instincts that the best decision-making is often taken at the lowest level in large organisations and in this case it should take place as near as possible to the place where the patient has to be treated.

Just in case I am accused by The Guardian of reading my question, as I was last Friday, I shall put my notes down on the Bench.

I sympathise with what the hon. Gentleman says about reporting in The Guardian. It is because we have such experiences that I do not always answer questions which begin, "If speculations in the press are to be believed". I ask the hon. Gentleman to wait until he has read the White Paper proposals and the arguments in favour of them. I should then be grateful for his contribution and comments on the arguments.

Does my right hon. and learned Friend agree that the introduction of a more free internal market within the NHS would contribute, first, to a reduction in waiting lists in some areas and secondly, to keeping the costs of treatment down; and, thirdly, would enable those doctors and nurses who are particularly good at providing certain kinds of treatment to offer their skills for the benefit of a larger number of patients?

There is now widespread interest in the concept of internal markets inside the NHS. The Government's review team has probably taken the work on internal markets and the possibility of turning that idea into a practical reality further than most other groups.

What assurance can my right hon. and learned Friend give the House that under the terms of the review urgent attention will be paid to the important aspect of putting managers in a position to manage without the unnecessary constraints of bureaucracy?

That must be an important aim in strengthening the NHS. We want everyone in the Health Service—managers, doctors, nurses and others—to be in a position to take clear, quick decisions in the interests of the patient. At the moment, as we all know, that clear, quick decision-making and choice of priority is not always made and the system is certainly capable of some improvement.

If the review is meant to cover the question of contracts for consultants, will it also cover the abuse that appears to be taking place whereby those consultants are recruiting their private patients from long waiting lists, particularly in the hip section and the ear, nose and throat section?

Waiting lists are shorter than they used to be and we are making progress in bringing down waiting times. The waiting times initiative has already enabled 200,000 extra in-patients and 120,000 extra day cases to be treated. The key is waiting times. I can assure the hon. Gentleman that the Government are determined to put a great deal of effort into getting waiting times down to more acceptable levels in areas and specialties where they are excessive, although in a great deal of the service and in many specialties there are no longer excessive waiting times and I am glad to say that we are making substantial progress.

Will my right hon. and learned Friend's White Paper next week also include his response to the Griffiths report on community care and if not, when we can expect that response?

No, it will not, but we owe the House and Sir Roy Griffiths and his colleagues a response to their report. It is an important subject and I hope to come forward with the Government's conclusions in the not too distant future.

Has not the Secretary of State's White Paper now been so thoroughly leaked that it is already shot full of holes? Now that he has been good enough to give us a date for bringing forward his White Paper, will he tell us when he intends to respond to the Griffiths report which has been gathering dust for almost a year? Does his White Paper say anything about community care for the elderly? Does he recognise that if the only thing that his White Paper offers the elderly is a tax subsidy for private medical care it will be transparent that the only health problems he is worried about are those out of which someone else can make a profit?

It is certainly true that there has been a great deal of speculation about the White Paper and it was predictable that the hon. Gentleman should denounce each and every proposal that he thinks we shall make. At least the knee-jerk reactions of the Labour party are now out of the way. I hope that we have cleared the ground for a serious discussion when the White Paper appears on 31 January. We shall follow it up with our reactions to and our decisions on the Griffiths proposals on community care as soon as possible.

To ask the Secretary of State for Health what the latest available figure is for the infant mortality rate; and if he will make a statement.

The latest available annual figure for the infant mortality rate in England and Wales is for 1987, and is 9·2 deaths per 1,000 live births. That is the lowest figure since records started.

I am grateful to my hon. Friend for that encouraging reply, but he will have received reports about the spate of cot deaths reported late last week. Such deaths are always traumatic for the parents. What steps is the Department taking to investigate the strange coincidence of six deaths within a matter of a few hours in a fairly narrow geographical area?

I agree with my hon. Friend that they are traumatic. There is no easy answer, but over the past eight years infant mortality, which includes cot deaths, has shown a significant improvement, from about 12·8 per 1,000 to 9·2 per 1,000. I assure my hon. Friend that I will pursue an explanation for the unexplained coincidence of a number of cot deaths with the health authorities in Surrey and Hampshire.

Given our poor standing in the international league table for infant mortality, why are the Government content to let so many babies die unnecessarily?

I do not accept the charge or allegation made by the hon. Gentleman. In comparing the record of this country with that of other countries one must bear in mind that we have a higher proportion of lower birth weight babies. That in turn may be due to the fact, as my hon. and learned Friend the Minister of State recently pointed out, that we have a higher incidence of teenage mothers who smoke.

I welcome the reduction in the perinatal mortality rates nationally, and certainly in the west midlands, but does my hon. Friend agree that that heightens the responsibility that we must show for pregnant mothers in my constituency, where I regret to say that the figure has increased to an all-time high? May I have an assurance that the Government recognise our problems and will investigate them without further ado?

I can give my hon. Friend that assurance. The Government certainly take this seriously. Since 1980 there has been a threefold increase in the number of intensive care cots available for such cases.

Although I welcome the movement to reduce the figures, can the Minister assure us that the policy of not operating on children with heart problems who have Down's syndrome is not endorsed by the Government? They can have such treatment in other countries.

The hon. Gentleman asked a detailed question, about which I shall write to him.

To ask the Secretary of State for Health to what extent AIDS treatment is made available to foreigners.

Whether free National Health Service hospital treatment for AIDS, or any other condition, is made available is not determined primarily by a patient's nationality but by whether the person is ordinarily resident in the United Kingdom.

My hon. Friend will have heard reports last year that almost half the HIV-positive patients in one London hospital came from Dublin. He will also know of allegations that in the Irish Republic AIDS patients are publicly named and forcibly segregated unless they leave. Will my hon. Friend undertake to the House that the British taxpayer is not spending taxpayers' money on an AIDS drain from the Irish Republic and other foreign countries?

I know of no evidence for any such AIDS drain. Of course, I shall consider any evidence—as against assertion—that my hon. Friend might have.

Given that the problem of AIDS is international and that its resolution can be found only through international co-operation, does the Minister share my concern that the major work undertaken by Dr. Jarrett at Glasgow university may well be threatened by the proposed closure of the veterinary school there? Will his Department therefore join the many people in all parts of the House and from all walks of life who are trying to dissuade the University Grants Committee from following that ridiculous course?

That was a rather contrived way of introducing a question which is for another Department to consider. If the hon. Lady feels that it is a matter for congratulation—as obviously she does—I add to the congratulations by commending her for her ingenuity, but I cannot add anything in my answer.

While it may be regrettable that some foreigners are taking advantage of the facilities in Britain, is it not the case that AIDS is a scourge and should be dealt with wherever it is found, especially if it is found in this country?

; I am sure that that is precisely right. In fact, in accordance with international agreements, anybody who wishes to have an AIDS test while in the United Kingdom can have one. Indeed, AIDS knows no national boundaries, nor can it ever be confined within one national area or continent. We must all work together to deal with that scourge. I hope that the House has been encouraged by the compliments paid to us by Dr. Jonathan Mann of the World Health Organisation for our efforts in giving a lead in this matter.

To ask the Secretary of State for Health if he will make a statement on the operation of the appeals procedure set up following the regrading of hospital staff.

These appeals are being dealt with under a long-standing general Whitley council agreement to which the nursing trades unions are a party and which they insisted should apply to the recent regrading exercise. I have asked health authority chairmen to adopt a range of measures aimed at ensuring that the appeals process works quickly and effectively.

Will the Minister tell the House to what extent his Department will make available overtime payments or extra staff, because of the increased workload of managers, regrading officers and union stewards involved in these appeal procedures? If that is his Department's intention, will he make available extra resources to cover that extra work?

All the staff who, in some places, have to put in a considerable amount of work to handle these appeals are being paid accordingly, and in line with national agreements which we have with them. I accept that in some places the appeals process is putting a considerable extra burden on management and in some places, no doubt, on the union side, too. We understand that shop stewards are finding it difficult to keep up with the number of appeals. It is a pity that in many places nurses and midwives have been encouraged to put in appeals, regardless of the merits. I believe that everyone is slightly paying the price for the fact that the system was, I dare say, deliberately overloaded in some places. I know that everyone is trying to ensure that the process is carried out and that cases of individual mistake are corrected as soon as possible.

Is it not the case that the vast majority of nurses and midwives are satisfied with the results of the regrading exercise and that a large number of the appeals against the decisions are politically motivated by the National Union of Public Employees and Confederation of Health Service Employees, which is using its own members—gulling and duping them and using them as their political war-horses rather than acting in their best interests by accepting what they have been given?

I believe that my hon. Friend's assertion is self-evidently true throughout the country. He accurately describes the position of the majority of nurses and midwives. COHSE, NUPE and the Labour party have tried to stir up discontent and have tried to make political capital out of the situation. Unfortunately, by overloading the appeals procedure in some cases, they have been getting in the way of those people who have a genuine query about their grading and wish to have it sorted out by a sensible appeals process.

Will the Minister make it clear to all health boards that enough additional resources will be made available to meet the results of successful appeals, and that the number of successful appeals will not be predetermined by the amount of money in the kitty?

The appeals are being determined in line with the guidelines which were set out when we started. They are not in any way determined by any artificial cash limit. I am satisfied that we have funded this generous nurses' and midwives' pay settlement in full. Indeed, we funded it in full using the health authority's own figures. I do not foresee any cash problems arising as a result.

I thank my right hon. and learned Friend for remedying the anomaly whereby fully qualified nurses when entering midwifery training were actually losing money, thus obviating the number of appeals. Will he now ensure that any charge nurse undertaking additional responsibilities—for example, moving from grade I to grade 2—will receive some salary increase at the same time?

We certainly were flexible on some of the points which arose in our discussions on the grading structure. One of the changes that we made was to deal with the problem of midwifery students, and I am glad that my hon. Friend is satisfied with the result.

Does the Minister realise that it was disastrous to undertake the regrading exercise at the present time? Is he aware that a lot of nurses are dissatisfied and will be leaving the Health Service? Can he guarantee that payment will be retrospective? As the reviews will take years rather than months, will interest payments be paid on top of the pay awarded?

I am sorry that the hon. Gentleman thinks that it was wrong to regrade the nursing profession and to provide the career structure that I have just described. The hon. Gentleman is criticising not only myself, the Government and the management of the NHS, but all the trade unions which were party to the regrading exercise and which, at first, welcomed the career structure that it created.

To ask the Secretary of State for Health if he has received any further representations from relevant interested groups and individuals on the proposed closure of the royal national orthopaedic hospital's accident and emergency unit at Stanmore, Middlesex, following the Minister of State's letter to the hon. Member for Harrow, East on 22 December 1988.

As at 18 January 1988 we had received five further representations.

After the sad and regrettable decision to close the unit, especially as it is so close to the Ml, I hope that, in future, the Minister of State will not underestimate the vital importance of keeping the rest of the hospital on its present site, if at all possible.

Obviously, I am sorry that my hon. Friend has reservations about the closure of the accident and emergency unit. He will be aware of the pressure that we are under as a result of the report from the Royal College of Surgeons and others, to ensure that accident and emergency units throughout the country are capable of dealing with the full range of emergencies that might come to them. That means centralising on a fewer number of sites but, in fulfilling that need, I regret it if it has had the effect of damaging my hon. Friend's constituents' confidence in the service.

To ask the Secretary of State for Health what steps he is taking to establish the costs of operating theatre procedures.

Information on average costs per operating hour is being provided by health authorities for the first time for the 1987–88 financial year and this will be published this summer. Our preliminary view is that such costs will be lower than the £450 per hour estimated by the National Audit Office.

Does my hon. Friend agree that that information is vital to enable managements to plan their operating theatre utilisation? Does he also agree that if that information was coupled with an enhanced roll-over provision for finance from one year to the next, there could be substantially better theatre planning, which would mean a reduction in waiting lists and in the costs of operations? I urge my hon. Friend to press for an improvement in the roll-over provision.

I can hold out no hope to my hon. Friend that we will change the percentage—the ability to carry forward up to half a per cent. of the combined revenue and capital limits. I agree that there is scope for improved planning. We need better financial and management information systems and clinicians in the Health Service need to become more involved in the management of resources, including operating theatre usage.

When considering the costs involved in carrying out kidney transplants, will the Minister consider the allegation that, in the private sector, two Turkish men were paid £2,000 to provide their kidneys for transplant? What action is his Department taking to outlaw such procedures?

The Government have made it plain that commercial trade in vital organs is absolutely abhorrent and unacceptable. I have asked Bloomsbury health authority to investigate the allegations.

My hon. Friend will have to provide information not only about costs, but waiting lists. Will he ensure that information about the excellent practices of efficient theatres is disseminated throughout the country so that those authorities that lag behind can bring themselves up to scratch?

Yes, we shall ensure that that is done. The waiting list initiative, which will be worth ?31 million in the next financial year, is likely to result in increased treatment for more than 100,000 in-patients.

When the figures are available, will the Minister ensure that there is a health warning attached to them explaining how they are affected by operating sessions being stood down and patients being telephoned on the morning that they are due to go into hospital and being told that they cannot have their operations? By how much will such incidents affect the figures that the Minister will produce?

About 10 per cent. of all operating theatre sessions are planned and then cancelled for a variety of reasons. The hon. Gentleman is right to draw attention to the fact that there could be better planning by health authorities, surgeons and consultants in the use of operating theatres.

Is my hon. Friend aware that the operating theatre costs at the eye, ear and throat hospital in Shrewsbury would be greatly increased if the pre-med and recovery areas were not situated in corridors? It is time that the regional health authority was sacked or made to act on this disgraceful matter.

That is a matter for the local health authority concerned. However I assure my hon. Friend that I will pursue his point.

I welcome the Minister to the Dispatch Box for the first time at Health questions. Does he agree that the most important factor of an operation is not its cost but its outcome as to mortality or morbidity? In the light of the review, what are the Government's plans for collecting information on mortality and morbidity and what considerations are they giving to making that information available, and in particular to whom?

The hon. Gentleman must await the National Health Service review for some detailed proposals. However, it is certainly the Department's policy to collect up-to-date statistics and I shall ensure that they are more regularly available to the House.

To ask the Secretary of State for Health what the in-patient waiting list figures were for the Trent regional health authority in March 1988, 1987 and 1979.

There were 54,900 patients on the in-patient waiting list in Trent region at March 1988. That is a 5 per cent. reduction over March 1987 when the list stood at 57,700, and 25 per cent. lower than the 72,900 patients on the list at March 1979.

Is it not a fact that Trent regional hospital has treated more out-patients and that with extra funding even more patients will be treated? Does that not give the lie to the scare stories put about by the Opposition?

Between 1978 and 1986 the number of in-patients treated in the National Health Service increased by 19 per cent., and in my hon. Friend's own region the increase was even more impressive as there was a 28 per cent. increase in the rate of in-patient treatment.

Is the Minister aware that the waiting lists in the Trent region remain disgracefully high? My constituent, Mr. George Brown, aged 82, who is tortured with pain so that he can scarcely sleep, has been told that he can see an orthopaedic surgeon in October, 10 months after his doctor recommended that he should see a surgeon with a view to treatment and surgery? Will the Minister please take steps to deal with that case and with other similar patients waiting in agony in my constituency.

The hon. and learned Gentleman must take the matter up with his local health authority, but am sure that he will welcome the initiatives that the Government have taken over the past few years and for the forthcoming year. There has been a waiting list initiative of £25 million per annum in the past, and £31 million is being provided next year to treat more than 100,000 in-patients more quickly than otherwise would have been possible.

I am sure that my hon. Friend will agree that the resolution of the waiting list problem in Trent and in Nottingham owes as much to the RAWP formula as it does to the special initiatives that I know my hon. Friend has taken. Therefore can I say yes please to his special initiatives and to the continuation of the RAWP formula which will help my district and my area?

I am grateful to my hon. Friend. He will welcome the fact that my right hon. and learned Friend the Secretary of State has recently announced increases in allocations to health authority regions of about 2·5 per cent. per annum in real terms for next year. These are additional resources which will go a long way to help not only with waiting lists but with improvement in patient care.

To ask the Secretary of State for Health what proposals he has to improve retention and recruitment of scientists and technicians in the National Health Service.

I understand that the management sides of the appropriate Whitley councils are investigating the nature and scale of reported problems. It is for the management and staff sides of the Whitley councils to consider what, if any, further action should be taken.

Is that reply not hopelessly complacent in view of the acute shortage of scientists in Oxford and elsewhere in the National Health Service, the vital nature of the work that they do and the fact that they are paid 40 per cent. less on average than scientists outside the service' Is it not scandalous that even now the very management side to which the Minister refers is threatening to withdraw the miserable 5·5 per cent. pay offer that was made for the as yet unresolved negotiations which were supposed to be settled last April? What is the Minister doing through the management side to tackle this matter, which puts patient care at risk?

It is extraordinary that the hon. Gentleman commends the Whitley council system—the opposition on the council prevents any reform of the system—but then invites Ministers to move in and push the system aside. I am bound to point out to the hon. Gentleman that, whatever he may say about this, that, or the other problem affecting scientists in the National Health Service, the number of scientists in the service has gone up by 57 per cent. since 1979.

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

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.

Has the Prime Minister noted the comments of her hon. Friend the Member for Thanet, South (Mr. Aitken) who last week said that MI5, after the general election of 1979, fingered six Conservative Members of Parliament as unsuitable for office? Will the Prime Minister confirm that she received a report on each of those Members? Will she also confirm that each of those Members has been blacklisted for ministerial appointment? Does she not believe that all those Members have a right to know what charges were made against them so that they can clear their names?

I noted the comments of my hon. Friend. The hon. Gentleman the Member for Workington will not be surprised at my reply—indeed he could almost have dictated it as he studied his question. I follow the rules of my predecessors: I do not comment on security matters.

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

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

As my right hon. Friend is in overall charge of policy and in charge of the policy review committees, can she assure the House that the members of those committees, and particularly the Ministers, enthusiastically and regularly attend those meetings? I ask because in the latest edition of the Tribune it is said that due to lack of interest, due to lack of attendance, seven national policy committees have been cancelled by the Labour party.

rose—

Order. I trust that the question was about Ministers, not about the Opposition.

As regards my responsibilities, I confirm that my colleagues, right hon. and hon., regularly and punctually attend all committees, and are skilful, forceful and effective in their comments and in the implementation of policy following such meetings.

Is the Prime Minister aware that, recently, thousands of pensioners who last year received a mediocre—a small—increase, over and above their basic pension entitlement, which was due to a heating allowance or some such payment, have been told not to expect any increase in their pension from next April? How would the Prime Minister and her husband like to live on a pension of £55 a week with no increase?

The hon. Gentleman knows that all the special sums allocated to heating allowances for particular people were lumped together and distributed among those entitled to income support so that they received it regularly. That was done with the approval of the House. The hon. Gentleman also knows that the upratings for pensions in the future have been announced. Unlike the Labour party's figures, they follow precisely the RPI figure, and there was no fiddling with the RPI figure.

Is the Prime Minister aware that many people are deeply opposed to the Griffiths proposals that town halls should devise care packages for the elderly and handicapped? What about the family, the family doctor and the district nurse?

We shall consider precisely what to propose to the House on the Griffiths report but that will not be before the National Health Service review has been completed.

Will the Prime Minister confirm that her Government take a bigger share in taxation from the incomes of the majority of families and earners than any Government in history?

The overall burden of taxation is falling. It is true that there was a time under the previous Labour Government when the burden was less than it is now. That was because they borrowed so much—[Interruption.] Indeed, borrowing went up to 9 per cent. of GDP because they had neither the skill nor the guts to cover their expenditure by taxation. They left the debts for us to repay.

Why cannot the Prime Minister give an honest answer to an honest question? Does the Prime Minister recall saying that the share of the nation's income taken by the state must be steadily reduced? Can she tell us why, under her Government, it has been increased to a higher level than under any previous Government, Conservative or Labour?

The right hon. Gentleman's Government borrowing requirement rose to 9 per cent. of GDP which—in terms of today's money—meant that they were borrowing the equivalent of £40 billion a year. We are now having to tax to repay the debt that they created. They always leave debts saddled around the necks of their children.

My right hon. Friend the Prime Minister will know that I am not one of those who constantly asks for more spending of taxpayers' money. However, did she hear the recent remarks of my noble Friend Lord Blake about the dire straits of our historical records and great manuscripts that are in danger of being permanently damaged unless more funds are made available to look after them properly?

My hon. Friend will know that this Government set up the English Heritage foundation and gave it substantial finance to ensure that there was sufficient money available to keep those objects that are particularly valuable. There are also other Government agencies that protect and look after our heritage. I am sure that Lord Charteris will look into these matters.

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

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

What advice does the Prime Minister have for young families and couples who face mortgage increases of £50 and £60 a month? Has she the same advice as the Chancellor, who said that people in those categories must make cuts elsewhere?

Quite obviously, those people—particularly those who very recently purchased houses and, therefore, did so at the top end of the market—are having particular difficulty with mortgage increases. That does not alter the fact that we must put the reduction of inflation at the top of the list, and we have to do that through interest rates. Those who purchased their houses before that time, have enjoyed a considerable increase in capital. Indeed, as the hon. Gentleman knows, often those who lend money to others to purchase houses do not do as well as those who buy the houses.

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

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

Will my right hon. Friend accept my congratulations for the support which she is giving to the world ozone conference? Does she agree that the destruction each year of an area equivalent to Great Britain of Brazilian rain forest highlights another major threat to the world? Will she outline to the House the measures that the Government intend to take to alleviate the problem?

My hon. Friend knows that the second part of the world ozone conference is being held in London on 7 March when we hope to cut the emissions of chlorofluorocarbons by 85 per cent. from what they were. We have already reached our target of cutting them by 50 per cent. We think that we should go further. The other matter which he mentioned has more to do with carbon dioxide, or the greenhouse effect. The cutting down of tropical forests on the present scale is having an adverse effect. The overseas aid Department, under my hon. Friend the Member for Bath (Mr. Patten), takes into account the willingness of countries to keep their tropical forests when giving aid to them.

Since when?

If the right hon. Gentleman had been listening to what I said before—of course, he was not here—he would have known that this is not a new policy. It indicates the great significance which we attach to the keeping of tropical rain forests.

Does the Prime Minister share the view expressed earlier by the Secretary of State for Defence that no responsible British Government should rule out the possibility of having to fight, and presumably win, a conventional war in Europe?

I am not quite certain what my right hon. Friend said but we both hold precisely the same view—[Laughter.] That could have been better put, could it not? I am not certain whether the hon. Gentleman's report of what my right hon. Friend said is correct; indeed, I doubt it. Let me make it clear; conventional weapons, however strong, have not been enough to prevent war from starting. That is the lesson of history. Conventional weapons alone have not been enough to prevent the start of world war. We believe strongly that it is vital to have a nuclear deterrent. It is that which has kept the peace in the last 40 years.

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

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

Given that health care has been, is and will continue to be provided on the basis of need and not on the basis of ability to pay, does my right hon. Friend agree that the Pavlovian reaction of distress from the Opposition Benches is completely synthetic in view of the fact that the review is designed to inject added efficiency to ensure that resources for patient care go further?

Certainly the Health Service will continue to be available as now on the basis of those who need health care getting it at the time when they need it. One point of the review is to get better value for money from the enormous extra resources in money, nurses and doctors which are being put into the service. The National Health Service is steadily increasing its efficiency. We now treat 1 million more in-patients and 2·5 million more out-patients a year than 10 years ago. That is a considerable achievement.

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

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

Did the Prime Minister see "Panorama" last night, which showed the Salvation Army handing out stale bread on council estates in Scotland? When will the Prime Minister come out from that bullet-proof Daimler of hers and start visiting some social security offices and council estates up and down the country to see the stale bread society that she is creating for millions of people?

Nonsense. The hon. Gentleman is quite aware, and dislikes it intensely, that the level of spending on social security exceeds anything that was available under his Government. I must say to the hon. Gentleman that I thought his comment was a great insult to the Salvation Army.

Following the inauguration of a new American President last Friday, will my right hon. Friend find the time to convey to former President Reagan the thanks of the House for his great contribution to world peace and to NATO? Will she also find the time to express to President Bush the best wishes of the House for his terrn of office?

Immediately before he left office I expressed our great thanks, and our appreciation to President Reagan for all that he has done for sure defence and for extending freedom the world over. On the day of his inauguration, I expressed our congratulations and best wishes to President Bush, and assured him that we would continue to be a true and faithful ally in defence of freedom.

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

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

If the economy is as strong as the Prime Minister has been saying, why do sections 1, 2, 3, 7 and 11 of the Disabled Persons (Services, Consultation and Representation) Act 1986 remain unimplemented, despite being given Royal Assent more than two and a half years ago?

I had the impression that two sections had come into effect and that we were ready to implement the third when we have secured agreement from local authorities. In the meantime, may I point out that, because the economy is strong, we have been able to spend about 90 per cent. more in real terms on the disabled than any previous Government.