To ask the Secretary of State for Health what representations he has received about the provision of powered wheelchairs; and if he will make a statement.

We have received a number of representations about the provision of indoor and outdoor powered wheelchairs.

After the success of the pilot schemes in Manchester and Newcastle, will my hon. Friend make sure that sufficient funds are available to maintain national progress? Will he see what can be done to reduce the very high costs of powered wheelchairs?

As my hon. Friend knows, it was always the intention that the services that are currently run by the Disablement Services Authority should be transferred to health authorities with effect from April this year. We have set in place arrangements that will ring-fence the funding that is currently granted to the Disablement Services Authority for two years, to ensure that, in the immediate aftermath of the transfer, the real level of provision will be maintained.

Does the Minister think it fair that some of the most disabled people in Birkenhead are those who are least likely to get a powered wheelchair? If he does not think that that is fair, what will he do about it?

What we are doing about it is that, from April, the local health authority will have the resources available to make a properly prioritised decision about the way in which those resources should be used. It will be for the hon. Gentleman to take up that matter with his local health authority to ensure that the people who need such services have them provided.

Will my hon. Friend take advantage of this opportunity to pay tribute to the work of the various associations for the disabled and the St. John Ambulance brigade, whose work makes the lives of those who rely on wheelchairs much more normal?

I am happy to take the opportunity that my hon. Friend presents to pay tribute to the role of the voluntary agencies in this and many other matters related to health. It is right also to take this opportunity to draw attention to the valuable work that has been done by the Disablement Services Authority, which was set up by my right hon. Friend the Prime Minister when he held a different brief. It has made a substantial improvement in the efficiency with which resources are used to the benefit of the patients who use such services.

Is not it the general view, after the pilot experiments in Manchester and Newcastle, that the Government's offer of £1 million in response to the DSA's request for £10 million is woefully inadequate? After all, we are talking here about independent living for people who would otherwise have to rely on much more expensive institutional care. Will powered wheelchairs be available for casualties from the Gulf if, ultimately, they can be of help?

The decision on the provision of a powered wheelchair for an individual patient will be for health authorities and clinicians. From April, the £112 million budget for disablement services—the provision of wheelchairs and of artificial limbs—will be transferred to local health authorities so that they can use the resources in a way that reflects local priorities. That seems to be the most effective way of ensuring that resources are well used.

To ask the Secretary of State for Health what guidance he is giving to regional health authorities about the time scale to be adopted in transferring the funding of districts to the capitation system; and if he will make a statement.

All regional health authorities have submitted details of their proposals for achieving funding based on weighted capitation at district level. We are analysing the method and pace of change proposed by the regions and will be formulating a national policy and timetable shortly.

As authorities such as Southend, which has traditionally been woefully underfunded, were looking forward to the new Government proposals that would give them a fairer deal, is my right hon. Friend aware of the serious concern, first, that there might be an unduly extended time scale for change and, secondly, and more important, that the regional health authorities can adjust the figures as they see fit to make allowances for what they assess as deprivation? Bearing in mind the fact that regional health authorities are not subject to any democratic control, will my right hon. Friend see to it personally that they do not undermine his excellent plans?

I am aware of the anxiety in Southend because my hon. Friend has made his concerns clear to us. There are two aspects of the matter. First, it is fair to say that the potential gains for Southend, which will come through in the end, must be set against the disruption to the losers in the process. It is fair to take a little longer so that the disruption is tolerable. Secondly, I can set my hon. Friend's mind at rest that all the formulae produced by the regions will have to come to my Department for approval and I shall ensure that they are fair.

Is the Secretary of State aware that he should not be too tolerant with the regional health authorities? I endorse what was said a moment ago. If the Secretary of State does not insist on the authorities allocating resources on a weighted capitation basis, underprivileged areas such as north Staffordshire will not receive the money to which they are entitled. Will the Secretary of State press them strongly?

I can give the right hon. Gentleman the same assurance as I gave earlier. The plans put forward by the regions will be carefully scrutinised in the Department to make sure that they are consistent and sensible.

While warmly welcoming the minimum 10 per cent. cash increase, which should make it a great deal easier to introduce weighted capitation at district level, may I ask my right hon. Friend to take into account poor beleaguered Essex, which year after year has suffered cash shortages in the national health service? Will my right hon. Friend do what he can to support our new regional chairman, who is very able and supportive?

I strongly endorse what my hon. Friend said about the regional chairman, who is strengthening management throughout his area. I take my hon. Friend's point. He understands why I have slowed down by, I hope, no more than a year the move to full weighted capitation at the regional level so that there is not too much disruption in the process.

To ask the Secretary of State for Health what steps he has taken to ensure that the best medical facilities in this country are available when needed to treat Gulf war coalition casualties; and if he will make a statement.

To ask the Secretary of State for Health what representations he has received with regard to the additional resourcing requirements of hospitals likely to be caring for possible casualties of the Gulf war.

Health authorities have made arrangements to treat British Gulf casualties. The national health service will be able to recover the full costs of such treatment.

Has the Secretary of State heard the Prime Minister's warning that Saddam Hussein might soon resort to the use of chemical weapons? Does he agree with the views of medical experts that in the worst-case scenario, our burns and plastic surgery units might be overwhelmed with thousands of casualties? Is he satisfied that health authorities are taking all immediate steps to increase the number of staff available in such units, as it is likely that staff, rather than equipment and buildings, will limit the number of people who can be treated quickly?

Yes, Sir. I am satisfied that the health service is well prepared. The remarks to which the hon. Gentleman may be referring were originally made by Professor McGrouther, a great man in plastic surgery. I am happy to say that last week he said that he was quite satisfied that the health service is fully prepared.

Will the Secretary of State give an assurance to the House that no patients will be turned away from hospitals before any Gulf casualties arrive in Britain? If it has to happen, will he ensure that national health service patients share the sacrifice equally with private patients in national health service beds?

We do not believe that it will be necessary for patients to be turned away from hospitals or for wards to be emptied at present. It is worth remembering that if the worst comes to the worst and there are many casualties, there will be a considerable warning time before patients begin to arrive in national health service hospitals.

Is my right hon. Friend aware that I have checked with Northampton district health authority and in particular Northampton general hospital and that I have only the utmost praise for the preparations that have been undertaken? May I say a particular thank you to the Department of Health?

I am grateful to my hon. Friend. I join him in saying that the Gulf crisis shows the health service once again at its very best. The speedy co-operation that has been exercised between the different levels—region, centre, district and hospital—is exemplary.

Will my right hon. Friend confirm that the Government will meet the full extra cost of Gulf casualties so that any increase in waiting lists does not last too long?

I give my hon. Friend that assurance in the clearest terms.

While accepting the Secretary of State's assurance about the immediate care of casualties, may I ask about their long-term care? Will they be left to depend on local charities or will adequate provision be made for them in their communities?

The hon. Gentleman makes a fair point. The Ministry of Defence and the forces have considerable expertise in the matter. My hon. Friend the Minister for Health will be answering a question later today about the role of the social services in this.

Did my right hon. Friend see the televised broadcast on behalf of the Soldiers', Sailors' and Airmen's Families Association during the weekend and does he agree that the point might be misinterpreted? Will he confirm that there is plenty of room for rehabilitation and recuperation for any Gulf casualties and that the private sector will not have to contribute places?

As I said, the national health service and the organisations that are accountable to the House are well prepared for any challenge that may face them.

In view of the Secretary of State's welcome assurance to my hon. Friend the Member for Pontefract and Castleford (Mr. Lofthouse) that it should not be necessary for hospitals to turn away patients now, may I invite him to comment on a letter that I have seen that was sent to a woman in her 80s advising her that many operations have been cancelled at the hospital in question because beds are already closed for Gulf casualties? Does he agree that it would be wrong if elderly patients were to become early casualties of the Gulf war? Will he urge health authorities to meet the new emergency not by closing even more beds but by bringing back into service some of the 27,000 that have been closed under Conservative rule?

If the hon. Gentleman had been interested in receiving a serious reply to a serious question, he would have been courteous enough to raise the matter with me earlier. If he will send me the letter, I will give him a proper reply.

Although the treatment of Gulf casualties may mean the postponement of non-urgent operations, may we be assured that there will be no diminution in the ability of the NHS to respond to civil emergencies such as multiple car crashes or the recent Cannon street train crash?

My hon. Friend's point is entirely fair. I have been assured by the chief executive of the health service that it will be able to maintain its emergency cover for civil emergencies. It is worth remembering that compared with the scale of activities of the NHS, which treats about 8·5 million cases a year, even the worst-case scenarios about which the commentators have been telling us should be relatively well within its capacity.

To ask the Secretary of State for Health what plans he has for a review of hospital services in the Manchester/Trafford area following the opting-out decision by central Manchester hospitals.

None, Sir.

Is the Minister prepared to put on record in this place what his colleague in another place told me in a letter: that when the new children's hospital is built in central Manchester—on the same site as the now to be opted-out hospital—it will itself be considered for opting out? Is he aware that in the north-west region we already have about double the national child mortality rate and that in central Manchester we have triple the rate? Is the Minister aware that the people of the region do not want opting out, which is irrelevant to their needs, but the resources to make sure that our children do not die?

No hospital has opted out of the NHS and we shall not entertain a proposal from any NHS hospital to opt out of the NHS. NHS hospitals are not for sale. The change that we are introducing is designed to give more power to the local management teams of hospitals to use the resources devoted to those hospitals to the best advantage of the patients.

Will my hon. Friend explain why Christie hospital in Manchester has refused to supply the drug interleukin to my constituent Mrs. Kendrick, even though it had been prescribed by Dr. Thatcher of that hospital? Does this have anything to do with the reorganisation of hospitals in Manchester?

It has nothing to do with the reorganisation of hospitals. There has been some discussion of the subject in the press today and I make three simple points about it: interleukin does not have a product licence in this country or in the United States; one manufacturer of the drug has decided not to proceed with clinical trials because of doubts over its efficacy, and the decision not to use the drug in Christie hospital was taken by the drug and therapeutics committee of that hospital before Christmas, nine of the 12 members of that committee being medical people.

In view of the Minister's reference to the minute of the 12 consultants, may I remind him that it clearly specified that the consultants decided that there was general support for interleukin, but that the treatment could not be used within existing funds? Is not it clear from the very committee from which he quotes that its decision not to proceed with a drug that had been used in that hospital for four years, regardless of whether it had a licence, was due to the deficit at Christie hospital? Three years ago, even this Government met hospital deficits with extra funds, not extra cuts. Does not the Minister appreciate that the response to the case shows that the public would much rather that the Christie hospital deficit was cleared by the taxpayer than by not treating Mrs. Kendrick?

Is the hon. Gentleman inviting the House to put his clinical opinion ahead of that of the Committee on Safety of Medicines or the Food and Drug Administration? The use of that drug in Christie hospital was part of a clinical trial and the hospital's drug and therapeutics committee decided that there were greater priorities for the use of the resources available to the hospital. The Labour party is as explicit as the Government in proposing that the only way to run a publicly funded free national health service is on the basis of there being a limit to the resources available to fund it.

To ask the Secretary of State for Health what is the rate of heart attacks in (a) men and (b) women (i) under 50 and (ii) over 50 years.

In 1989, the death rate per 10,000 population in England from acute myocardial infarction was 1·03 for men and 0·13 for women under the age of 50 and 68·81 for men and 45·88 for women over the age of 50.

I thank my hon. Friend for her reply. She is saying that young women hardly ever have heart attacks or strokes, whereas the number of women over 50 who suffer those conditions is rapidly catching up with the number of men. They are the largest single cause of death for women in that older age group. Is my hon. Friend aware of the research work carried out at King's College hospital showing that hormone replacement therapy is a way to protect women from such an early death? Will she state the amount of money currently spent in the health service on making hormone replacement therapy available to women in that older age group?

It would be difficult to be in this place with my hon. Friend without having a passing acquaintance with the subject of hormone replacement therapy and the work undertaken at King's College hospital. She has identified the important contribution that the treatment can make. We spend £29·5 million in the health service on hormone replacement therapy and the number of prescriptions has tripled over the past 10 years. Although there is evidence of the contribution of HRT in preventing cardiovascular disease, it is not conclusive. My hon. Friend must bear with us while further research is undertaken to assess the effects of HRT on those with osteoporosis and cardiovascular disease.

Will the Minister comment on the stark contrast highlighted by the Public Accounts Committee's report on coronary heart disease? In this country we spend£10 million on prevention and £500 million on the treatment of the biggest killer, which kills 3,000 people a week. That stark contrast in expenditure shows that the Government need to respond to the need for prevention.

I appreciate the hon. Gentleman's recognition that prevention is better than cure. I hope that he will join us in carrying forward our strategies and priorities for health. Certainly, the prevention of heart disease—whether through the GPs' contract, the "Look after your Heart" campaign or environmental and lifestyle factors, especially smoking—is crucial. The hon. Gentleman will know that treatment is also costly. The number of heart transplants has risen from three to 295 in 10 years and the number of coronary artery bypass grafts has risen from 3,100 to almost 13,000.

To ask the Secretary of State for Health how many general practitioners have opted to become budget holders; and if he will make a statement.

I am pleased to be able to tell my hon. Friend that there are currently around 300 practices undertaking the preparatory work necessary to become fundholders from 1 April.

Does my right hon. Friend agree that the essence of the internal market in the NHS is choice and that if it is to succeed, more general practitioners must be encouraged to take up budget holding and more hospitals, such as Wrightington on the edge of my constituency, must be encouraged to become national health trusts?

The benefits of both systems are becoming increasingly understood. Both systems are voluntary, but tremendous benefits are available to patients from the GP fund-holding scheme—a matter which I hope that Opposition Members will consider in due course, because it would be paradoxical if that aspect, which is aimed at giving help to patients and those most directly representative of them, should run into opposition from the Labour party.

Is the Secretary of State aware that the denial of interleukin-2 to a patient at Christie hospital shows the problem of fixed budgets? In a written answer to me the Department of Health said that that drug could be used on a named patient. The drug and therapeutics committee said that the drug was not being prescribed not because it did not agree with it in principle but because

"this could not be achieved within existing funding."

Order. This is an important matter, but the question was too long.

My hon. Friend the Under-Secretary of State has dealt with the matter once. I repeat that the truth of the matter is that the drug and therapeutics committee of that hospital took an entirely sensible view that against the background of doubts about the drug—[Interruption.] The hon. Gentleman will find that at the time the meeting took place the committee believed that the drug had a product licence whereas in fact it did not. Other, more expensive drugs are still being prescribed in the hospital.

My right hon. Friend will be aware that the Select Committee on Health will be carefully monitoring the effects of the NHS reforms. If he and his colleagues wish to remain closely in touch with what is happening at the grass roots, will he accept an invitation from Cumberland house, the largest general practice in my constituency, which has opted for budget-holding status, to discuss what it sees as the advantages and some of the expected problems of budget holding?

I visited my hon. Friend's constituency not very long ago, and very pleasant it was, too. I will try to fit another into my programme. I also visited two proposed budget-holding practices in East Anglia and south London, and I was very impressed by the enthusiasm shown at both. They will rapidly offer patients significant benefits.

To ask the Secretary of State for Health what proposals he has to introduce a system of limited drug prescribing for qualified nurses; and if he will make a statement.

We support the principle of nurse prescribing. The advisory group report on nurse prescribing and comments received during the consultation period identified a number of issues that require further work, which we are urgently carrying forward.

Although the Government's support for limited nurse prescribing is welcome, does the Minister acknowledge the suspicion that the Government are using delaying tactics by establishing independent cost benefit analysis of some of the problems that the consultation process reveals? When will we know the terms of reference of that analysis, and may we have an assurance that if it suggests that additional costs will be incurred because people who do not currently receive prescriptions will do so in future, that will not be a deciding factor in vetoing the scheme's introduction?

I hope to disabuse the hon. Gentleman of such suspicions. The cost benefit analysis is important, and we hope to announce the details shortly. We will certainly make all the information available. However, there are other issues to be considered—such as deciding the precise formula, training, and the relationship between nurse and general practitioner prescribing. It is a complex matter, but the concept has strong support and we shall carry forward that work.

Is my hon. Friend aware that many practice nurses would welcome a limited prescribing arrangement? With proper training and a sensible list of drugs, it should be possible for nurses to relieve their practitioners of regular prescribing, thus releasing them for other work. When that bright initiative is in place, will the nurses be encouraged to prescribe generically, as is done in hospitals?

My hon. Friend makes a strong case, for nurse prescribing, as did my hon. Friend the Member for Kensington (Mr. Fishburn), when he introduced his ten-minute Bill last week. Such an arrangement would help not only practice nurses but health visitors and district nurses. Many argue that they, too, could helpfully prescribe a limited range of items. With the greater emphasis being placed on community care, those other categories could certainly play a fuller part. I give my hon. Friend the assurance that he seeks. We are carrying forward that work and we want to see nurses play their part in prescribing.

To ask the Secretary of State for Health whether he proposes to make changes to the powers of the NHS management board.

The NHS management board has not existed since 1989. I have no plans to make changes to the powers of the management executive that replaced it.

Will the Secretary of State ensure that before all the management board members dwindle away to take up high-paid jobs in self-governing hospitals, they do something about the plight of low-paid NHS workers? I refer particularly to blood transfusion workers in the northern region, who have waited two and a half years for a pay regrading under the guidelines issues by the management board. Everyone is praising those workers, rightly, at this time—but will the Secretary of State ensure that they get properly paid as well?

The management board has already dwindled away, because it no longer exists. However, I take the hon. Gentleman's point and he is right to say that there are too many low-paid people in the health service. In the negotiations on ancillary pay, we should try to shift attention towards the lowest-paid.

To ask the Secretary of State for Health what is the current funding of Project 2000.

In this financial year, we have provided£30 million from central funding for the implementation of Project 2000. Next year, £71 million will be available.

Although the Royal College of Nursing has expressed concern that the speed of funding does not match the desire to implement Project 2000 as soon as possible, will my hon. Friend confirm that when it is in place throughout the country, its training provisions will make nursing a most attractive profession for the future?

I can certainly give my hon. Friend that assurance. The East Suffolk, Great Yarmouth and Waveney nursing school in my hon. Friend's constituency was among those that received approval in the first wave. By the end of next year, half the nurses training will be in Project 2000 courses, by which time we shall have spent £109 million. That is a rapid rate of progress and, while I understand the desire to implement the scheme even faster, we are content with the speed at which Project 2000 courses—which lay the foundation for the professional nurses of the future—are introduced.

Is the Minister aware that, laudable though the aims of Project 2000 are, some area health authorities are strapped for cash and are finding it difficult to identify proper campus sites for training nurses? Mid Glamorgan is a classic example. It is being forced to consider closing down the excellent rehabilitation centre at Talygarn to house nurses.

My right hon. Friend recently announced our plans to carry forward the work on the Peat Marwick McLintock report on nurse education and its management, and also the work of working paper No. 10. We understand that there needs to be proper organisation of nurse training within the regions. I cannot comment on the hon. Gentleman's area, but can say only that, within the English health authorities, good headway has been made in introducing Project 2000 and we are certainly considering nurse education in a broader context as we look to the future.

To ask the Secretary of State for Health what funds the Government have allocated to the voluntary hospice movement.

On 9 January I announced the allocation of an additional £16·96 million to health authorities in England for 1991–92 to enable authorities to increase the support that they give to hospice organisations. Last year that figure was £8 million.

Does my hon. Friend agree that her figures confirm the Government's support for the increasing role that the voluntary hospice movement is playing, alongside the national health service? Will she continue to monitor the costs of that movement, not least when it has to face unexpected costs such as national pay awards, and also when it loses money as a result of decisions taken by local Department of Social Security offices not to recognise voluntary contributions by patients to the running of those hospices?

My hon. Friend speaks with authority about hospices, as the Trinity hospice provides a service for many of his constituents. Questions of income support are for my right hon. Friend the Secretary of State for Social Security—it is not the case that the higher rate is paid for those for whom no charge is made. I understand that his hospice received in the order of £443,000 last year from the health authority and from money made available by central Government. That was a 25 per cent. increase on the help that it received the year before.

Can the Minister confirm that this welcome increase in grants to the hospice movement is partly based on the fact that it covers a wide spectrum of the public potential, and partly because it provides a unique service between hospice and home? Will she also confirm that, due to effects of the hospice upon the statutory service, any additional expenditure saves money elsewhere?

I have no doubt that any additional money is providing good value by ensuring a quality service. All of us would want to pay tribute to the voluntary hospice movement and the work that it has undertaken in pioneering a quality service for the dying. The hon. Gentleman is right to identify not only those in hospice beds, but the excellent work achieved by hospices at home. With the rapid expansion in the voluntary hospice movement, it is important to integrate planning, consideration and provision between the voluntary hospice movement and national health service provision. We are proceeding with work to ensure that the two develop in tandem and in a spirit of co-operation.

Is my hon. Friend aware that the voluntary hospice movement is most welcome in all parts of every constituency and that this further help from the Government will be welcomed by the movement?

I thank my hon. Friend for endorsing the warm tribute that all of us would want to pay to the hospice movement. The number of hospice beds has doubled in the past 10 years. As well as providing additional funding this year, we have decided to establish a research project into standards of palliative care and have also asked the Standing Medical Advisory Committee and Standing Nursing and Midwifery Advisory Committee to report back on the organisation of hospice care.

To ask the Secretary of State for Health when he next expects to meet the chairman of the Trent regional health authority to discuss the hospital bed situation in the Sheffield health authority.

When I next meet Sir Michael Carlisle I shall congratulate him on the fact that the number of in-patients treated by Sheffield health authority has increased by 52 per cent. since 1979. I shall also congratulate him on the fact that in-patient waiting lists in Sheffield have fallen by nearly 14 per cent. in the last 12 months, while the number of people waiting for more than 12 months is down by 56 per cent. over the same period.

Nevertheless, 286 hospital beds have been for financial reasons lost in Sheffield over the past year. Red alerts continue, inevitably throwing a greater strain on surgical beds and waiting lists, out-patient facilities and the staff who must work the beds a good deal more intensively as a result. Does the Minister believe that the factual statment is a matter for congratulation?

The hon. Gentleman's difficulty is that he is pushed back on press releases and on repeating already well-repeated formulae. What seems more important to me is the fact that Sheffield health authority has shorter waiting lists and is treating more patients than ever before.

To ask the Secretary of State for Health what advice he has given to social services departments relating to the care of service men injured or disabled in the Gulf conflict; and if he will publish it.

The Department has today written to social services departments setting out the arrangments made by the Ministry of Defence and the national health service for treating Gulf casualties. I have placed a copy in the Library.

I thank my hon. Friend for that reply. Does she realise that, in the event of a land war, there will probably be a number of seriously disabled casualties and that, when the national health service has done all that it can to stabilise their condition, some will require accommodatiton suitable for people in wheelchairs? Can my hon. Friend assure me that she will consult her colleagues in the Ministry of Defence and the Department of the Environment to ensure that sufficient accommodation of that kind is provided—even if it is only temporary—so that the houses in which those unfortunate people must bring up their families can be assessed with a view to adaptation?

As my hon. Friend will know, the Ministry of Defence has well-organised arrangements for the welfare and support of casualties and their families, but, as he pointed out, it is difficult to make predictions. It will be important for local authorities to keep in close touch with the MOD and, if necessary, the Department of the Environment. We shall certainly play our part in that.

Is the Minister aware that social services departments in London are currently under great pressure? They will all wish to provide the maximum resources and support for any Gulf casualties, but will the Minister make it clear to them that the Government will provide all the necessary resources?

I remind the hon. Gentleman that social services departments throughout the country have been given the largest increase in their standard spending assessments for 15 years—an increase of 23·5 per cent. We anticipate that local authorities will be able to respond to circumstances as they normally do in civil emergencies, and will play their part. As the letter makes clear, in the first place they will need to work closely with the Ministry of Defence, and use their existing arrangements for supporting casualties and their families.

To ask the Secretary of State for Health what new initiatives he is considering to combat coronary heart disease.

Combating coronary heart disease is one of our biggest challenges. That was why we launched the joint Department of Health/Health Education Authority "Look After Your Heart" programme in 1987. A new five-year strategy was recently launched.

Is my hon. Friend aware that the number of people who die daily in this country of premature coronary heart disease is equivalent to the number of passengers on a fully loaded jumbo jet? Does she realise that the four constituent parts of the United Kingdom are among the six countries with the world's worst record of coronary heart disease? How does she react to the report of the Standing Medical Advisory Committee on cholesterol testing, and, in particular, to the idea of giving general practitioners information about how to deal with patients with above-average cholesterol levels in their blood?

As my hon. Friend rightly says, there are about 160,000 deaths each year and about 35 million working days are lost each year through coronary heart disease. Although our record for coronary heart disease was extremely severe, I can assure my hon. Friend that we have already beaten the World Health Organisation's health-for-all target of 15 per cent; we have seen a reduction of 24 per cent. in our coronary heart disease rates. We want to do very much better. The report by the Standing Medical Advisory Committee on cholesterol testing is still being considered, but most certainly general practitioners, like the Health Education Authority and the health service generally, have a full part to play in combating this cause of early death.

Does the Minister agree that one of the most significant contributions that we can make to the reduction of coronary heart disease is to reduce the incidence of smoking in the population? What steps are the Government taking, therefore, to curtail the advertising of smoking and why are they seeking to gut the Bill brought forward by my hon. Friend the Member for Warley. East (Mr. Faulds), which would certainly significantly reduce smoking among children and the younger age group?

I endorse the point made by the hon. Gentleman; something like 20 per cent. of the deaths are associated with smoking. We spend around £3 million campaigning to reduce smoking. It is deplorable that those under 16 should be sold cigarettes. I very much hope that we can take further steps to prevent this. My right hon. Friend the Secretary of State is today consulting on the tobacco labelling directive, further wording and the attention that can be drawn to the fact that smoking damages health.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 February.

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.

Is the Prime Minister aware that, as the recession bites even deeper in all parts of the country, not least in the west midlands, the country will simply not buy the nonsense that it is all due to the Gulf war? Is he aware, further, that people recognise that the recession and the devastation that are occurring in so many parts of the country are due to the disastrous policies of a discredited Government who simply do not know from day to day where they are going?

I certainly accept that there is a downturn in the economy and I have made that clear. But the hon. Gentleman must recognise that that downturn, in terms of investment and growth, comes from a very high level after a very lengthy period of growth. It is absolutely essential that we take the appropriate decisions now to ensure that we have a lower rate of inflation in the economy in the 1990s.

Is not my right hon. Friend greatly encouraged by the fact that British investment outstrips that in Germany, France and Italy? Does not he think that British industry is getting rather fed up with the Labour party continually saying that there is no end to the recession in sight and no economic good news? Does he agree that it is becoming the party of the abominable no-men?

As my hon. Friend knows, our investment record over recent years has been extremely good—a record unmatched elsewhere in the Community.

Since it is clear that before too many weeks have passed the Government will be forced to cut interest rates, why do they not do it now and save British industries and British home buyers absolutely pointless pain?

The right hon. Gentleman should not be so desperate. If he panics in opposition, what might he do in government?

First, all observable panic is on the right hon. Gentleman's side of the House. Secondly, he will soon have a very good opportunity of finding out the strength of Labour in government.

The right hon. Gentleman has clearly overlooked the fact that—[Interruption.]—I shall come directly to the question. The right hon. Gentleman has clearly overlooked the fact that there is a recession in a number of countries. The right hon. Gentleman misunderstands the importance of interest rates. Nobody wants interest rates to be unduly high, but we need to ensure that we have a low inflation economy. That is the means to ensure that we have it.

I am sure that my right hon. Friend is aware of the many Gulf support groups that have been set up throughout the country to offer help and support to those families who have loved ones fighting in the Gulf. Will he join me today in sending best wishes to the two groups in my constituency, in Batley and Cleckheaton, who are doing a superb job?

I am certainly happy to do as my hon. Friend requests. I am delighted by the number of Gulf support groups that have been set up around the country and I wish them all well.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 February.

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

Can the Prime Minister tell us how this war can have any moral or democratic purpose when British troops risk being slaughtered on the desert sands while the Kuwaiti royal family is gallivanting around the gambling dens and casinos, living it up? When the war is over and those Kuwaiti American stooges are back in power, with all their luxury, some British troops will be coming back to the dole queue, the poll tax and cardboard city. Is that the classless society that the Prime Minister talks about?

I always thought that the hon. Gentleman was against the sort of actions that we have seen in Kuwait by the Iraqis. I am sorry that I am wrong.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 February.

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

During my right hon. Friend's busy day I am sure that he will share my concern about the current proposals for reform of the common agricultural policy. Does he agree with me that we should not accept any reform that penalises the efficient British farmer, since that will not help the British consumer?

I agree with my hon. Friend. I share the view of the majority of hon. Members that further reform of the common agricultural policy is needed, but that must make European agriculture more, not less, open to market forces. As my right hon. Friend the Minister of Agriculture, Fisheries and Food has been making clear in Brussels, we shall very strongly resist any proposals that penalise the efficient farmer and, in so doing, place the burden upon consumers.

Does the Prime Minister recall the very welcome words of the Foreign Secretary at the weekend when he said that when the fighting is over we must be prepared to use the peace wisely? May I therefore put to him this proposition: if the United Nations provides the authority for fighting the war in the Gulf, the United Nations should have the responsibility for building the peace that follows it. Does the Prime Minister agree?

We shall certainly be discussing, both within the United Nations and beyond—with the Arab states that have the primary interest—what is necessary for the future security of the region.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 February.

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

Has my right hon. Friend noted that for the last four months inflation has been running at about 1·9 per cent. per annum? Does not that show that the Government's policy of reducing inflation is working? Does not such a policy offer a far more certain way towards eventual interest rate reductions than the soft option advocated by the Leader of the Opposition by way of a devaluation?

My hon. Friend is right. Soft options tend to lead to hard times. Our policies are succeeding in reducing inflation. As inflation comes down there will be the opportunity for sustained interest rate reductions.

Does the Prime Minister agree with me—

I saw the hon. Lady on television.

So did I.

Does the Prime Minister agree with me that, in keeping with the spirit and purposes of the United Nations, consent to the allied military action is limited to ending Iraq's occupation of Kuwait, that peace and security in the region can be achieved by other means, and that those means must include the removal of nuclear and chemical weapons throughout the region?

The present aims are set out perfectly clearly in Security Council resolutions. As to the second point in the hon. Lady's question, I think that it is a matter that everyone will wish to address after the conclusion of the conflict.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 February.

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

Does my right hon. Friend agree that, whatever our party politics, we should all welcome the proposed abolition of the apartheid laws in South Africa? Does he agree also that, whatever we may think about that country's past, the best way to support its Government now is to help them make those changes as quickly as possible and to begin the process of reintegrating South Africa into the community of nations?

I agree with my hon. Friend that it is necessary to support the South African Government. But perhaps even more relevant is support for the people of South Africa—all of them. President de Klerk has made a truly massive move forward and it is now for the international community to respond. I hope very much that it will do so. I have already discussed the matter with the Secretary-General of the Commonwealth and with President Bush, and my right hon. Friend the Foreign Secretary raised it with European Community Foreign Ministers yesterday. I spoke about it this morning with Mr. Hawke, the Australian Prime Minister. He and I agree very strongly that the time has come to begin lifting the Commonwealth measures, especially the sports sanctions, particularly in the case of those sports that are integrated in South Africa. All in all, the announcement by President de Klerk was a most welcome move forward.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 February.

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

Is the Prime Minister aware that the naval base at Rosyth in Scotland employs 5,000 naval and civilian personnel? Is he aware that we have received ministerial assurances that, in the defence review, all the options will be considered impartially? Is he aware of a secret study report showing that there is an intention to close Rosyth in the shortest possible time? Does not he agree that it is disgraceful that at a time when our naval personnel are serving in the Gulf, their home base is being threatened in this way?

No decision has been made to close Rosyth or any other naval base. We fully recognise the implications that closure would have for employment in the area. Those implications would be fully considered and examined before any such decision was taken.

Can my right hon. Friend assure the House that if President Bush raises the question of transatlantic air routes he—the Prime Minister—will sustain the Government's position, as outlined by the Secretary of State for Transport, in a very strong and sensible defence of British civil aviation?

My right hon. Friend the Secretary of State for Transport is discussing these matters. I can assure my hon. Friend that my right hon. Friend will defend our interests very robustly.

How does the Prime Minister justify the salary of £225,000 per annum being paid to the new chairman of British Coal? Previous chairmen had a large industry and a comparatively small salary, whereas the present chairman is inheriting a very small industry and will have a large salary. Some of us suspect that his terms of reference are to make the industry smaller still.

The gentleman concerned is being paid according to his ability.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 February.

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

Reverting to reform of the common agricultural policy, does my right hon. Friend agree that if, for social reasons, the Germans and French wish to subsidise their small farmers, they should be free to do so? As the British taxpayer will next year spend £4 billion on agricultural subsidies, apparently to produce inadequate incomes for farmers and excessively high prices for consumers, is not it time we considered repatriating agricultural policy so that we can decide what is best for Britain?

The common agricultural policy is an established element of the European Community. I share my hon. Friend's view that it is an unsatisfactory one, and for that reason we are seeking to reform it.

Is the Prime Minister aware that a measure of the underlying weakness of our economy is the fact that, excluding North sea oil, in the past three and a half years, at constant prices, we have had a trade deficit of £85 billion? Why does he believe that we can solve that problem with the same rate of exchange that caused it?

The right hon. Gentleman is selective in his criticism. He wholly forgets that we had eight successive years of growth, a period in which our investment has grown faster than that of Germany, Italy, France and anyone else in the European Community and we now have a wholly different industrial position from that which we inherited in 1979.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 February.

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

Is my right hon. Friend aware of the concern of many firms operating in the financial services sector about the European Commission's draft directive on capital adequacy? Does he agree that some of the requirements imposed on capital adequacy are excessive, and will he make vigorous representations to ensure that, where appropriate, they are reduced?

I am aware of the concerns that my hon. Friend raises. He will know that firms that act purely as advisers are exempt from the requirements of the capital adequacy directive. We do not wish to see inappropriate or unnecessary capital requirements imposed on any United Kingdom investment firm.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 February.

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

Under the private Bill procedure, the Government have always accepted their neutrality to be one of support for a private Bill. Last Thursday night, the Southampton Rapid Transit Bill was defeated by the use of the payroll vote, including 10 members of the Cabinet, two of whom are members of the War Cabinet, which was suspended when that vote took place. What has changed the Government's mind? Was it political judgment or political spite?

The hon. Gentleman should know that that was the individual decision of Members of this House.