To ask the Secretary of State for Health if he will publish the views of Coopers and Lybrand Deloitte commissioned by his Department on the self-governing trust implications from St. James's hospital, Leeds and Leeds general infirmary; and if he will make a statement.

No, Sir. The appraisals are confidential documents prepared to help inform my assessment of proposed national health service trusts.

That answer is most disappointing because the budget submissions from Leeds general infirmary and St. James's are based on massive underestimates of inflation and on land sales and a large increase in private beds, and it is widely believed that a third of the applicants for self-governing trust status are already massively overspending on their capital budgets. Why cannot the Department make available to the House a full appraisal including all the financial facts, so that the Government can be fully publicly accountable for budget decisions in this crucial area?

We are fully accountable and I stand accountable to the House. A range of different advice was offered to us and there would be no more point in publishing the bits that the hon. Gentleman wants than there would any other bits. They were my decisions, taken against the background of the information available to me.

But is not the reality that those two great hospitals, St. James's and Leeds general infirmary, are among the largest in Europe and that the only way in which they can fulfil their potential and deliver the best service to their patients—which after all, is what it is all about—is by stripping away excessive layers of bureaucracy? In today's world, is not self-governing status within the NHS the best way of achieving what really matters, which is patient care?

My hon. Friend knows these hospitals well and he puts his finger on the fundamental point. Many of the people who object to the return of those hospitals to management from within the hospital probably objected when the bureaucratic system was set up from which they are now escaping.

To ask the Secretary of State for Health if he has any plans to review the annual budgeting system of family health service authorities.

From next year, it will be for regional health authorities to determine the allocations which are given to family health services authorities and to ensure that they have adequate internal financial arrangements.

I accept in principle the idea of annual budgeting by family health services authorities, but does my hon. Friend accept that the establishment of new doctors' surgeries, particularly in urban areas, requires some co-ordination between the purchase of land and the design and construction of buildings? Does not a rigid annual system with a strict limit on the 12-month budgeting period work to the detriment of the creation of new surgeries?

My hon. Friend has a longstanding constituency interest in the arrangements for distributing the substantial resources for the premises improvement scheme. More than £6 million was spent last year on such schemes in his family health services area and he will know that 67 of the 87 practices there have benefited. However, it is important to continue to ensure that the vast resources put into practitioner services are properly and effectively distributed. If there are aspects that we can look at more carefully, we shall certainly do so.

Given the significant contractual arrangements in the family doctor service, particularly during the past year or 18 months, and the anxiety that was expressed by many hon. Members on both sides of the House about the likely impact of some of those changes on employment prospects for female general practitioners, what evidence does the Minister have of the continuing employment on a part-time or full-time basis of female general practitioners?

The hon. Gentleman will not be surprised to know that I share his concern that we should continue to use women doctors in the NHS as well as we can. Half the medical students now are female and they should have an important part to play. The general practitioner's contract has meant that the specialties that many women doctors traditionally took up are particularly popular. We are watching the way in which women doctors are used. For the first time they can be employed as part-time principals, but they have expressed concern about the way in which they are likely to be treated by some male principals—[Interruption.] I have regular meetings with the organisations representing women doctors to ensure that we do not need to issue further guidance and that their skills are being fully used. [Interruption.]

Order. Could these Christmas greetings below the Gangway be exchanged outside the Chamber?

To ask the Secretary of State for Health what progress is being made in publishing the budgets of national health service trusts.

There are no plans to publish NHS trust budgets.

I fully accept my hon. Friend's comments. He may be interested to learn that, owing to the illegibility of my profession's handwriting, what should have appeared as "publicising benefits" has appeared on the Order Paper as "publishing budgets". Despite that, will he confirm that he will encourage national health service trusts to apply some of their budgets to promoting the benefits of NHS trusts to our constituents, notwithstanding the pessimism of my trade union, the British Medical Association?

My hon. Friend draws attention to one of the benefits of computerising prescriptions—they will in future be more legible. He is also right to stress the importance to patients of the improvements that come from trusts. The Kingston Hospital Trust, which serves my hon. Friend's constituency, was recently approved by my right hon. Friend. It promises to set specific waiting times for patients, to open evening and weekend clinics where there is substantial demand and to set down and follow discharge procedures so that GPs are fully involved in patient discharges. Those are the sort of improvements in the quality of service that can come from an imaginatively run trust.

Although the Minister has made it clear today that he will not publish NHS trust budgets, will he make public the full costs of wining and dining those concerned with the opting-out process? Can he justify the expenditure of £10,000 last Tuesday night on a Banqueting house booze-up for those concerned with opting out at a time when a health authority such as Wakefield has had to close 100 beds because of a lack of Government funding?

The hon. Gentleman asks a question and then establishes that it would be otiose to answer it because he already knows the answer. What is important is to establish the benefits that come from improving the management of NHS hospitals through their establishment as trusts. The accountability that matters is accountability to patients through the contracting system and the improvement in quality of service that it will provide.

Will my hon. Friend underline the point that, whether it is benefits or budgets, the role of the Audit Commission has been significantly enhanced by the National Health Service and Community Care Act? Will he ensure that the Department gives every possible support to the work of the Audit Commission, which does its best to ensure the best value for money for patients from the much-enhanced sums that we are now spending on the health service?

My hon. Friend is right. The Audit Commission has an important part to play in drawing attention to the opportunities, through more effective management, to obtain better value for money for the taxpayer and a better quality of health for the patient. That should be the objective of us all.

Is the Minister aware that there is some anxiety among social workers that there may not be adequate provision in national health service trust hospitals for social workers, bearing in mind the fact that we are trying to move people into the community and that social workers are employed by local authorities? Is he satisfied that the budgets provide adequately for such social services?

I am satisfied that the contracting system provides the mechanism whereby district health authorities will be able to provide the seamless robe that is essential to proper health and social care, to ensure that an individual benefits first from health care, then from community care and then from social care support when appropriate. The contracting system provides the mechanism for ensuring that all that is in place.

To ask the Secretary of State for Health what steps he has taken to reduce health inequalities.

It is a fundamental objective of our national health service reforms to give patients, wherever they live in the United Kingdom and regardless of how well off they are, better health care and greater choice.

Does the Minister agree that it is now 10 years since the Black committee report on inequalities in health? Can he explain why, in those 10 years, inequalities in health have got worse instead of better? Is not that a damning indictment of the abject failure of the Government to tackle the problems?

The thing to remember is that everyone's health has got better in the past 10 years, as it did in the previous 10 years. Life expectancy has increased by about two years for everyone. I am not going to say that our Government have abolished inequalities in health care any more than the Labour Government did when they were in power. However, we are introducing some powerful new mechanisms that will help. For example, the GP contract, although it has been unpopular with some GPs, is raising the level of immunology—for example, child immunology—in the places where it was worst. When Opposition Members say that they are going to repeal that contract, will they be satisfied with lowering the levels of child immunology again?

My right hon. Friend may have omitted to mention another important part of the reduction in inequalities with regard to the contract, as elderly people now have regular checks, which was not previously the case. Can he give us any information about that?

My hon. Friend is right. That, too, is an important weapon to help us move away from those problems, which occur throughout the world. Another relevant matter is that, under the new financial system, health districts will for the first time have the duty to produce a proper health plan for their area, taking into account the problems of social deprivation that they may face. That should also help.

Is the Minister aware that under the health plan, school children in Strathclyde are receiving letters telling them that they will no longer get eye tests in school and that they will have to go to hospital? Is that the type of planning that he wishes to see?

What I am aware of—although I hope that I do not embarrass my right hon. Friend the Secretary of State for Scotland by saying this—is that the situation in Scotland at least shows that there is no simple connection between resources and health, because Scotland spends rather more than we do in England per head, but has no better health statistics.

Is my right hon. Friend aware that, despite the millions and millions that the Government have rightly put into the national health service, regional and local health authorities are at best muscle-bound and at worst insensitive in much of their public relations? Will he bear that in mind and try to do something about it?

It is important that health districts and regions should have clearly designated spokesmen to answer questions that it is legitimate for people to ask them. I think that I should be criticised in the House if I encouraged them to launch large public relations campaigns. However, I take my hon. Friend's point. There must always be a clear contact point for inquiries from the public at district and regional level.

To ask the Secretary of State for Health what further representations he has received over self-governing hospitals.

I have received many representations about national health service trusts.

I can well imagine it. Is it of no concern to the Government that there is no public support for these substantial changes? For example, in my borough, at the district general hospital, there is overwhelming opposition to what is being proposed. Why are the Government pursuing this path of Thatcherite dogma, instead of dealing with the financial crisis in the health service? It would be far better to deal with the financial crisis, which is due to underfunding, than to gamble with people's health by making unnecessary changes.

I spent a large part of yesterday at the Royal Free hospital, where I met many people—doctors, nurses and health service workers—who are strongly in favour of the changes. They may all have been passionate Thatcherites, but I am not sure that they were. Some may even have voted for the Labour party. I think that the hon. Gentleman will find that there is growing support. One should consider the hon. Gentleman's area, where the National Union of Public Employees sent out 2,700 ballot forms. Four hundred came back and 100 were actually in favour of the trust—I suppose that they went to the wrong people. It is really not very serious.

When considering the representations made to him by hospitals or authorities that want to opt out and become self-governing trusts within the national health service, does my right hon. Friend give more weight to the views of members of the area health authorities, consultants and other doctors, nurses, paramedics, other staff and patients, or to those of the rather remote chairmen of the regional health authorities?

I should probably attach the most weight to the quality of the submission made by the hospital or other unit in question. Those are the people who know most about a hospital and whose future rests with it. If they present good proposals—as they did this year—it is principally to those proposals that we respond, although we also take advice from the districts and regions.

Although the Secretary of State keeps saying that there will be consultation, he never announces what sort of consultation it will be and with whom it will take place. Who will he consult before the trusts are set up—the patients, the staff or the public? If he is not satisfied with the NUPE ballot, why does not he organise a ballot himself? Is he aware that no consultation has taken place with Bassetlaw hospital, except that which I have tried to organise, with no help at all?

Ballots are not at all the right way to improve the system of management in a great service such as the national health service. We have been trying to carry out the statutory duties imposed on us by the Act that was passed earlier this year and, above all—as I said to my hon. Friend the Member for Macclesfield (Mr. Winterton)—to study the representations made to us by the hospitals themselves.

Following the undoubted success of hospital trusts, will my right hon. Friend find a mechanism whereby hospitals that are not currently part of the NHS—for instance, former military hospitals such as the one in my constituency from which the RAF is to withdraw—can become independent trusts within the NHS and thus build on the success of this initiative?

I know the hospital to which my hon. Friend refers very well; indeed, I talked about it to the regional chairman and officers when I was in Cambridge last Friday. I am not sure that the establishment of a trust is the most likely solution in that instance, but the regional authority is willing to consider any financial proposals that make sense and could save the hospital.

Can we tempt the Secretary of State to tell us something about the independent representations that he commissioned from Coopers and Lybrand Deloitte? Can he confirm that that organisation concluded that only 14 of the 56 applications that he approved were financially sound? If that was not its conclusion, why does the right hon. Gentleman keep refusing to publish its report? Should not the public have the right to know the figures and should not Parliament have the right to debate them?

The hon. Gentleman has misunderstood the nature of the process. During the summer, Coopers and Lybrand Deloitte and many other advisers produced a variety of advice, much of which was passed back to the trust units and altered in the course of dialogue with them. It is as futile to ask for that particular piece of paper as it is to ask for thousands of others that were made available to me.

To ask the Secretary of State for Health what plans he has to meet the chairman of the North West regional health authority to discuss the future of Prestwich hospital.

The future development of hospital facilities at Prestwich hospital is a matter for the local health authority.

Is my hon. Friend aware of the widespread opposition among my constituents to plans to develop a hypermarket on part of the hospital site? Will he join me in urging the chairman of the regional authority to tell his counterpart in Salford to withdraw the plan and thus save my constituents from serious environmental and commercial damage?

As my hon. Friend knows, this is a planning matter that falls within the responsibility of my right hon. Friend the Secretary of State for the Environment. Nevertheless, I cannot be blind to the fact that the £12·5 million that is in prospect if the planning proposal goes ahead would allow for a £6·5 million investment in new regional mental illness facilities on the Prestwich site and a further £6 million to improve provision for the mentally ill in the community. At a time when we are constantly—and rightly—pressed to provide investment to improve facilities for the mentally ill, that is a major advantage to which, as I have said, I cannot be blind.

Is the Minister aware that that hospital in Prestwich and other hospitals throughout the north-west region and Cumbria send patients to St. Paul's eye hospital in Liverpool for jag laser treatment? Is he further aware that that hospital is also under threat and that it is causing deep concern throughout the north-west? Will he take some action to ensure that people in Liverpool, my constituents and people throughout the region are satisfied about the future of those services?

The hon. Gentleman has got it completely wrong. The "threat" in Prestwich is that there should be a £12·5 million investment programme to improve hospital facilities and facilities for care in the community to provide for the mentally ill. That is the sort of threat that we want to see to develop an improving health service for all patients in the health service and especially, in this context, for the mentally ill.

To ask the Secretary of State for Health what initiatives have been or are being undertaken to improve out-patient departments.

We are committed to improving out-patient departments. We have recently issued advice on the physical environment, questions of skill mix and on appointment systems to reduce waiting times at out-patient departments. In addition, we are funding 10 demonstration projects as part of our quality initiative, addressed particularly to out-patient departments.

I am grateful to my hon. Friend for that answer and for the initiatives that have been taken to improve out-patient facilities. The improvements that have been made over the years in North Warwickshire district health authority are very much appreciated. How many new out-patient attendances were there in 1979 and how does that figure compare with those today?

There has been a considerable increase in the number of people coming to out-patient departments. There were 36 million out-patient attendances last year, which is 7 per cent. higher than in 1979. In my hon. Friend's health authority, the figures have increased by 20 per cent. over the past four years.

What out-patient facilities does the Minister plan for the over-85s? Six old people's homes have closed in Newcastle as a result of poll tax capping and two long-stay geriatric hospitals are closing as a result of hospital cuts, with the inmates and patients being put up for auction. Clearly, we shall need a lot more facilities at out-patient departments in hospitals to deal with the consequences of that, so what plans does the Minister have?

The hon. Gentleman will know that he has a first-rate health authority in Newcastle which is addressing precisely those problems. Its work on implementing community care is going very well. The point that my right hon. Friend the Secretary of State made a moment ago about the need for general practitioners to offer their patients who are over 75 an annual visit to check on their welfare and well-being will also help to improve the quality of care. We are seeing improved services for the elderly. Our community care proposals will challenge health and local authorities to work together successfully to ensure that there is comprehensive and integrated cover.

Has not the treatment of out-patients improved immeasurably over the past 10 years? Does my hon. Friend agree that the number of out-patients being treated at the moment in Leicester is at a record level?

I think that I can, almost without doubt, confirm the Leicestershire figure, but my hon. Friend will understand that I shall write to him if I am wrong. Out-patient departments are the interface between community services, general practitioners and hospitals. We are concerned that a recent survey found that 15 per cent. of people with out-patient appointments failed to show up in one area. We must be sure that our appointment systems are effective and that people are well treated when they reach the out-patient departments. We must also ensure that we are making proper use of skill mix and that the quality of the environment and experience is as good as it can be. We shall issue further advice to health authorities in the new year on the basis of the lessons that we have learnt from the first six demonstration projects.

To ask the Secretary of State for Health when he expects to announce Her Majesty's Government's policies for introducing assessment for patients leaving long-stay psychiatric hospitals and going into the community.

Guidance on the introduction of assessment for patients leaving long-stay psychiatric hospitals was issued to health and local authorities on 10 September.

In view of the great distress that has been caused to many patients who are leaving long-stay psychiatric hospitals supposedly to go into community care, which simply does not exist, when precisely will the Government implement section 7 of the Disabled Persons (Services, Consultation and Representation) Act 1986? Does the Minister recall that the former Secretary of State for Health announced, after over three years of negotiations with local councils, that the Government's National Health Service and Community Care Act 1990 and their provisions for community care transcended section 7, and that once that had been monitored, the Government would decide what they were going to do? Now that the Government have abandoned their proposals for community care until 1993, what will happen to the patients? Is that community care in the 1990s, or is it saying to those patients, "Look forward to cardboard homes and cardboard hopes"?

The hon. Gentleman is completely wrong. We have not abandoned community care; we are committed to implementing it. Furthermore, we are committed to implementing community care for mentally ill people on an accelerated timetable. The mental illness specific grant will make available £30 million of expenditure from next April. Capital approvals to local authorities will make available a further £10 million from next April. The capital loans fund has provided £10 million this year to invest in reprovision for mentally ill and mentally handicapped people. The initiative that I announced in July for homeless mentally ill people provides £5 million for that client group. Approximately £55 million has been made available by the Government in the current year to invest in improving the facilities available to treat mentally ill people in the community.

I warmly welcome the Government's proposals for improved assessment of people leaving long-term psychiatric hospitals and, more important, the provision of a key worker for each patient to co-ordinate the services available to him, but will the Government support and promote the additional voluntary service of Citizens Advocacy, a branch of which is in my constituency, which provides a friend—not a professional—to help formerly mentally ill or mentally handicapped people reintegrate into the community?

My hon. Friend rightly draws attention to an interesting and useful contribution to care for mentally ill people. I welcome the initiative that he referred to and the opportunities that it represents. The care programme approach that I announced on 10 September provides, for the first time, an ordered framework to assess the needs of each mentally ill individual and to ensure that they are met in the community. My hon. Friend referred to advocacy schemes, which have a part to play in that process.

Does not the Minister appreciate that it is the belief of millions of carers and the cared-for that. the Government have abandoned their community care programme? Sticking to the narrow confines of the question, does the Minister accept that the guidance for the assessment must be much wider than that which is published? How does it meet, for example, the criticism of the MIND survey, which mentioned the lack of choice and dignity, the lack of keys and the lack of the chance to keep pets? The survey in the west midlands found that virtually no social activity is offered in the private residential sector. How can it meet the problems that are caused by the lack of co-ordination between health authorities, social service departments and the planning authorities? In our large cities, hostels for mentally ill and mentally handicapped people are located next to another hostel, across the road from another hostel or round the corner from another hostel. Care in a community of hostels is not what patients or their families want.

It may be true that there is a belief in the field that community care has been abandoned, but it is quite simply wrong. When it has repeatedly been stated to be wrong, it does no one any good for the hon. Gentleman to repeat it from the Dispatch Box. As regards the suggestion that the care programme approach is too narrow, that was out to consultation throughout most of the summer, which offered an opportunity for those in the field to argue for the widening that the hon. Gentleman advocated. He did not do so and most of the people in the field did not do so at that time. The guidance that we published on 10 September represents the first structured attempt to ensure that the needs of an individual mentally ill person are assessed and that effective machinery is put in place to support that individual in the community.

Will my hon. Friend carefully consider respite care for the relatives or friends of psychiatric patients who return home? As well as the carers of psychiatric patients, many other carers need a break and we must cater for their needs in future programmes.

My hon. Friend is absolutely right. We recognise that respite care is an important part of a proper programme for community care for psychiatric patients and we shall ensure that provision is made.

To ask the Secretary of State for Health if he will visit Stepping Hill hospital, Stockport to discuss staffing levels.

I have no plans to visit Stepping Hill hospital. Staffing levels in hospitals are a matter for local decision.

Will the Minister join me in congratulating Mr. Graham Pink on having the courage to describe so movingly in The Guardian and on television the major problems faced in Stepping Hill on the night shift on geriatric wards? Will the hon. Gentleman condemn the district health authority for suspending Mr. Pink for his whistle-blowing activities rather than solving the problems at that hospital? Does he agree that that is deplorable?

No, Sir. I shall not join the hon. Gentleman in congratulating Mr. Pink. The trouble with Mr. Pink's allegations is that he does not have the support of his colleagues, the clinicians in the hospital or the health authority's chief nursing officer; nor can it be established on any of the published criteria that his allegations are justified.

The best way to improve hospital services in Stockport is to amalgamate Stockport infirmary with Stepping Hill hospital, which are both in my constituency. Is my hon. Friend aware that the consultant in charge of the accident and emergency department at the infirmary has been pushing for that amalgamation for years, yet it is opposed by the Labour party because of cynical, short-term opportunism? The Labour party is prepared to put lives at risk to buy short-term popularity. At Stockport infirmary there is no blood bank or intensive care unit and there are facilities to deal only with broken bones and ear, nose and throat problems. Unless a person suffers from such problems, he has to be taken by ambulance to Stepping Hill hospital, down one of the busiest roads in the north of England. That is the Labour party's wish.

My hon. Friend makes his point powerfully, but he is not quite right in every detail. Although the Labour party here opposes amalgamation, the National Union of Public Employees supports it, so my hon. Friend has support from a wider section of the community than he might have expected. He is right to draw attention to the improvement that can come from the investment programme to which he referred. I hope that it will be possible to provide for that within a reasonable time scale.

To ask the Secretary of State for Health what plans he has to meet the chairman of the National Association of Health Authorities to discuss the financing of the health service.

I look forward to meeting him on 31 January when I shall speak at his association's annual reception. I am sure that we shall discuss financial matters there.

Is my right hon. Friend greatly encouraged by the warm welcome with which his speech last week was received by the National Association of Health Authorities and the other caring professions? Coupled with the clear commitment of my hon. Friend the Minister for Health to cut junior doctors' working hours, does my right hon. Friend believe that that shows without doubt that the Government believe in a health service for everyone, financed primarily out of taxation and free at the point of delivery?

I am grateful to my hon. Friend. I should like to take the opportunity provided by his question to pay tribute to my hon. Friend the Minister for Health and to her including Dr. Diana Walford and Dr. Stephen Hunter, who have achieved what will turn out to be an historic breakthrough on the long-standing matter of junior doctors' hours.

Will the Secretary of State launch an urgent investigation into the funding crisis gripping the national health service in Bradford? Does he understand that, because of that cash crisis, there is widespread dismay at the fact that the Bradford NHS trust has gone ahead and still greater dismay at the fact that the chairman is a millionaire business man from Wakefield who knows nothing about the NHS in Bradford and still less about the health care needs of the people of Bradford?

It is astonishing that the Labour party should regret the fact that some of the best business men want to give their skills to the health service. That action will benefit the people of Bradford and that principle will benefit us all more widely.

Does my right hon. Friend agree that, although many Conservative Members are entirely behind the reforms that were introduced by his predecessor and which he carried through, in several areas—not least the Aylesbury Vale health authority and Stoke Mandeville hospital—a serious situation is developing as the hospital seeks to make ends meet before the new regime comes in next spring? As a result, there have been serious cuts in the number of operations performed. Will my right hon. Friend look at the overall costs of writing off the debts of those areas that are in serious financial difficulty, before the new regime comes in next spring, so that they can start with a clean slate?

It is understood that some of the London districts will not have to remove their deficits before the beginning of the new system. However, it would be a bad managerial signal to allow those that have overspent their budgets again to pre-empt resources that should be available to the whole of the health service, including those that have achieved their budgets.

Hon. Members of all parties have pointed out to the Secretary of State the immense pressure on health authorities from the obligation to remove their deficits. May I remind him that three years ago this week, one of his predecessors found an extra £100 million for a similar crisis in the hospital service? As beds are now closing faster than they did three years ago and as waiting lists are now longer than they were three years ago, why cannot the Secretary of State do the same? Why cannot the Government, who have written off the debts of every privatised industry, now write off the deficits of our hospitals?

The hon. Gentleman knows very well that it has been a long-standing objective to bring districts back into balance. That is the right thing to do and we shall continue to do it, although, as I said, there will be some flexibility in London. That remains the position.

To ask the Secretary of State for Health what advances have been made in transplant treatments in the last 11 years.

Over the past 11 years, there have been unprecedented advances in the number of organs transplanted, in the development of new forms of transplant and in improving the results of transplants. The Government remain wholly committed to the organ transplant programme.

Although I acknowledge that the United Kingdom's record on transplants is excellent, will the Secretary of State confirm the steps being taken by his Department to overcome the shortage in the supply of donor organs?

The main thing that the House can do is to redouble its appeals to people to carry donor cards. I am grateful to my hon. Friend for paying tribute to what has been done. It is an example of a wholly new health service activity—an almost completely new activity—in the past 10 years. There was virtually none of this under the previous Labour Government, which shows the development of services that we have been able to achieve.

It will come as a disappointment to the House that the Government's only contribution to increasing the number of donor organs is to increase the number of donor cards carried by individuals. Although that is successful to a limited extent, it is not proving sufficient to deal with the continuing problem of the shortage of donor organs. Have the Government no other plans to increase the number of donor organs available for transplantation?

As the hon. Gentleman quite likely knows, various other matters are under consideration. The United Kingdom transplant service, which is funded centrally from my Department, will continue to receive our support. We have considered alternative schemes, such as the opting-out proposal, which has been raised in some European countries. It has not found much favour with us and, from the expression on the hon. Gentleman's face, it does not find much favour with him.

To ask the Secretary of State for Health what are his plans for the future of the speech therapy profession.

Speech therapy services have expanded and developed considerably over the past 10 years. We are working with the profession on plans for further improvements.

Will the Minister acknowledge that, despite those efforts, there is still a chronic shortage of properly qualified speech therapists to treat communication-handicapped patients within the health service? Will she further acknowledge that urgent action is needed to increase the recruitment and remuneration in this valuable service and that the way forward is not to establish a tier of partially trained therapists acting as fully trained therapists within the service, but to put all the effort behind fully and properly qualified speech therapists?

There has been an 82 per cent. increase in qualified speech therapists over the past 10 years and they are better paid than they used to be. However, I recognise the hon. Gentleman's point that there are rising expectations of the number of tasks that speech therapists can rightly perform. It is important to consider the skill mix and to ensure that qualified speech therapists are used for the tasks for which their skills are necessary. We are also carrying forward plans for clinical audit. We have regular discussions with the College of Speech Therapists and we will continue to consider all the points to which the hon. Gentleman has referred.

In view of the standard of some of their speeches, will my hon. Friend provide speech therapy for the Labour party? [Interruption.]

That is a little bit wide.

I shall ask the Department's therapy officer to look at that aspect.

To ask the Secretary of State for Health what further steps the Government intend to take to reduce hospital waiting lists.

The NHS Management Executive is to agree tough targets for the reduction of long waits with all 14 regional health authorities. We are also continuing the special waiting list fund to help health authorities reduce the number of patients who wait excessively.

As the ENT in-patient waiting list in my area is 98 weeks and worsening, whereas ophthalmology, which has been given additional resources, has a reducing waiting list, will the Minister accept the general thesis that if more resources were given to hospitals, the waiting lists would lessen?

My right hon. Friend the Secretary of State for Wales is on the Treasury Bench and I know that he will note the hon. Gentleman's points. The numbers waiting for a long time have reduced. The hon. Gentleman will also be aware that 50 per cent. of hospital admissions are immediate. The average wait for those who come in off the waiting list is six weeks and we have seen great progress on the numbers who have to wait for over a year. We have made it clear that we want to take more time and care over reducing waiting times. At a time of increasing activity, it would be wrong for the hon. Gentleman not to recognise the progress that is being made.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 December.

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

Can the Prime Minister explain how the creation of hereditary baronetcies fits in with his idea of the classless society?

Order. The hon. Lady cannot ask about the royal prerogative. [HON. MEMBERS: "Why not?"] It is a long convention and it is outside our rules. The hon. Lady must try a different tack.

Is it true that the Prime Minister recommended the creation of a hereditary baronetcy? If that is the case—

Order. That is just as bad.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 December.

I refer my hon. Friend to the reply that I gave some moments ago.—[Interruption.]

Order. The whole House knows that we do not bring the royal family into our discussions here.—[Interruption.]

Does my right hon. Friend—[Interruption.]

Order. This is absolutely disgraceful behaviour. The House knows the rules about this.

Does my right hon. Friend share the enthusiasm of Conservative Members for the European Community's decision to lift sanctions against new investment in South Africa? Does he share my belief that only through that sort of investment can we bring peace and harmony to South Africa? Does he also share the belief of Oliver Tambo, expressed in his statement at the weekend, that the only people who wish to maintain comprehensive sanctions against South Africa are extreme elements of the African National Congress and the British Labour party?

The European Council's agreement over the weekend to lift the ban on new investment in South Africa was a positive step for which Britain has been pressing for some time. I hope that other Governments will soon follow the European Community's example. The very great changes that we have seen in South Africa in recent years have been welcome. In due course, I hope that they will be able to continue and that we will be able properly to welcome South Africa back wholeheartedly into the African and world community.

Will the right hon. Gentleman confirm that the number of homes being built in Britain is at a lower level than at any time since the first world war?

I confirm to the right hon. Gentleman that over the recent few years more people have moved into home ownership and we have had a higher quality and standard of housing than ever before.

I wonder why the Prime Minister is refusing to answer a plain question. I hear what he says, but, as the Government have cut £6 billion from housing investment and imposed the highest mortgage rates in all of history, does he not realise that the Government are responsible for not only the loss of homes but vastly increased homelessness?

The hon. Gentleman will find that his facts are incorrect. On the quality, nature and quantity of housing, I am happy to match the record of this Government against that of any previous Government.

Will the Prime Minister then acknowledge, first, that during the time that he has been Chief Secretary to the Treasury, Chancellor of the Exchequer and now Prime Minister, the Government have made huge cuts in housing budgets? Will he confirm that under this Government mortgage rates have been higher for longer than ever before and that while the Government have halved housing investment they have doubled homelessness?

In his list the right hon. Gentleman wholly overlooks the remarkable changes made to the voluntary housing movement, housing associations and action on homelessness.

Is my right hon. Friend aware that the chairman of the Bundesbank, Herr Pail, said the other day that interest rates should be set according to monetary conditions and should not be used to affect the exchange rate? Is he aware that many of my hon. Friends agree with that view and that if we use interest rates to maintain the exchange rate, we are likely to have a wider and deeper recession than we need to control inflation?

As my right hon. Friend knows, there is a clear relationship between interest rate and exchange rate policy. My right hon. Friend referred to the governor of the Bundesbank. The deutschmark is also part of the exchange rate mechanism and Germany has done rather well as a result of that.

Did the Prime Minister read the comments made at the weekend by the Governor of the Bank of England? He said that the Prime Minister's decision, when Chancellor, to cut interest rates in advance of the Tory party conference meant that his party gained a political dividend too early, for which jobs and industry are now paying.

The right hon. Gentleman should read all of what the Governor said. He made it clear that the matter was fully discussed with him and that a joint decision was reached.

Setting aside the argument that shops should obey the law—[Interruption.]

Order. I am not certain that that is a very good start.

Is my right hon. Friend the Prime Minister aware that there is a huge demand among shoppers and traders alike and an urgent need to allow people to shop on Sundays? Does he agree that the present law should be reformed?

The present law on Sunday trading is widely felt to be unsatisfactory, as my hon. Friend made clear. We tried to reform the law, but on that occasion our proposals did not find favour with the House. I can well understand the impatience of hon. Members about the state of the Sunday trading law.

Obey the law.

Order.

A great deal of the Sunday trading law is bizarre and the time may well be approaching when the Sunday observance lobby should sit down with the r: tail trade to see whether an acceptable compromise can be reached. As the House knows, there is an acceptable law in Scotland which has not wrecked the special significance of Sunday. I should welcome such a law in England.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 December.

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

Does the Prime Minister recognise at this time of seasonal goodwill the mortgage misery of millions of people who are paying considerably more than would otherwise be the case because of the Government's financial mismanagement during the past few years? Does he recognise that in the north-west an average mortgage of £34,800 is costing £110 a month more than it would have done two and a half years ago?

I understand clearly the problems faced by many people with high mortgage rates. The underlying necessity is to get the inflation rate down, and interest rate policy is a necessary part of that.

Is my right hon. Friend aware that every week many thousands of British animals are sent to antiquated European slaughterhouses and that they arrive hungary and thirsty, battered and damaged? Will he please take steps to stop this needless cruelty to and suffering of animals?

A great deal of that is unattractive. There are laws covering the circumstances in which such exports take place and I shall examine them personally, as my hon. Friend suggests.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 December.

I refer the hon. and learned Gentleman to the answer that I gave some moments ago.

What comfort can the Prime Minister give to my 89-year-old constituent, Mrs. Phyllis Smith, who, like thousands of other elderly people who live in rest homes, can no longer get free incontinence aids from the national health service? What would he advise her to do with bills for £179, such as this one, when she is on income support and cannot afford to buy these aids which are basic essentials of human dignity?

The hon. and learned Gentleman is as aware as anyone in the House that both the general level of provision and the specific level of income support are higher today than at any previous time.

Is my right hon. Friend aware that his calm and intelligent approach to the European summit and the negotiations has aroused widespread admiration in my constituency and across the country? My constituents recognise, as he recognises, that we have everything to gain from the negotiations, working out together with our European partners solutions to the many problems that face the European Community.

I am certainly grateful to my hon. Friend. It is clear within the EC that on some matters we have a distinct view and we shall sustain it. On those occasions we shall in future, as so often in the past, win the arguments.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 December.

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

The Prime Minister has spoken of creating a classless society. What sort of classless society will it be if, as forecast, unemployment once again goes beyond the 2 million mark? Why does he not at least take the advice of the Confederation of British Industry and reduce interest rates without delay?

It is because we are determined to bring inflation down and keep it down, not to bring it down artificially at the risk of a greater problem later.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 December.

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

Recently, the chairman of British Coal announced record financial profits—the best for 13 years. Recently, our miners produced an all-time productivity record of more than 5 tonnes per man-shift. Recently, the mineworkers' pension scheme announced an increase in pensions of more than 15 per cent. Will my right hon. Friend take this opportunity to congratulate all those people on making those records attainable?

I am certainly happy to do so. British Coal and its work force deserve great credit for their achievements, particularly for their recent record level of productivity. It will provide a firm foundation for the future of the coal industry.

Nobody can fail to have been impressed by the Prime Minister's stated conviction that everyone in this country has a right to his or her place in the sun and to equal opportunity. As we approach Christmas, will the right hon. Gentleman ponder on the plight of the Birmingham Six, who face their 16th year in prison for a crime that many believe they have not committed? When he ponders on that, will he join with me in my anger at the words of an Appeal Court judge yesterday—

Order.

—when he said—

Order. The hon. Member knows that that case is sub judice.

As the hon. Gentleman knows, a date is fixed for the hearing and in advance of that there is no more I can say at the moment.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 December.

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

During his busy day, will my right hon. Friend contact the commander of the British Forces in the Gulf and convey to him the best wishes and prayers of hon. Members in all parts of the House for all our troops as we rise for Christmas? Will he assure General de la Billiêre that our hopes remain high that Saddam Hussein will withdraw his forces from Kuwait without the need for further bloodshed?

I am happy to join my hon. Friend in those wishes. We owe a tremendous debt to our forces in the Gulf and I am sure that, without exception, we wish them a happy Christmas. I look forward to going out to visit them very shortly after Christmas.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 December.

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

As the Government's economic policy is leading to only one consequence, which is higher unemployment, may I ask the right hon. Gentleman to ask his right hon. Friend the Secretary of State for the Environment to ensure that more money is made available under the revenue support grant settlement for areas such as mine, where unemployment is already at double national average levels? Will he ensure that more money is made available in January by that means to alleviate some of the problems of that degree of unemployment?

The consequence of economic management next year will be lower inflation and renewed growth. My right hon. Friend will make a revenue support grant statement in due course.

On a point of order, Mr. Speaker.

Order. I will take points of order after the statement.