To ask the Secretary of State for Health if he will make a statement on the progress of health plans to meet health needs in regional health authorities.

Every regional health authority has submitted to my Department a plan for 1991–92 putting forward its key objectives and setting out levels of activity to be purchased to meet the health needs of its population. Regions are also developing strategies to improve health based on health needs identified in director of public health reports, which are published annually.

My right hon. Friend will be aware that inner London is facing considerable problems in adjusting to the new structures of the national health service because of the high cost of London teaching hospitals. Will he reassure my constituents that the availability and quality of their health care will be assured under the new contracts?

It is not fair to say that the problems facing London derive from the reforms. Everyone concerned with the national health service knows that there have been long-postponed issues to do with the division of NHS resources between London and the rest of the country, to which the reforms are indeed drawing attention. The regions and districts, together with the Department of Education and Science and those who have responsibility with us for teaching, must steer London carefully through the reform process.

If the Minister is so confident that the planning and changes that he is introducing into the NHS have support, why are the Government so intent on appointing so many card-carrying members of the Tory party to positions of responsibility in the NHS? Are the members whom he is appointing a greater or smaller proportion than the extraordinary number of Tories who have been appointed to positions of responsibility in Scotland?

I am not particularly interested in the party affiliations of those whom we appoint. We have appointed a good many people from other parties, although not, the hon. Gentleman will understand, within my responsibility, from his party.

Is my right hon. Friend aware—I gather from his answer to my hon. Friend the Member for Fulham (Mr. Carrington) that he is—that in my part of the world, in Lancaster and the north-west, we are glad that resources are at last being channelled to our area? We run our affairs prudently and are not short of staff or laying off staff.

My hon. Friend is right, and I do not think that, fundamentally, there is any division between the two sides of the House on the issue. There needs to be a fairer distribution of health resources across the country. The reforms are clearly resulting in our making decisions in London that have been long deferred by both parties. We must do that, but we must do it skilfully.

Why will not the Secretary of State publish all the business plans of all the trusts and all the documents that have been submitted by those organisations to his Department? The public should know the truth now. The debate in recent weeks has been about that, so let us see the documents and let the public know the truth.

The hon. Gentleman is wrong. The debate has not been quite about that. There are a variety of management documents for directly managed hospitals and trusts that have not been prepared for publication. Many trusts are perfectly prepared to publish the documents, and why should they not do so if they choose? But it would be unfair on them to change the goalposts half way through and ask them to publish internal management documents that were not prepared for publication.

To ask the Secretary of State for Health what assessment he has made of the impact of the Children Act 1989 on the handling of child abuse cases.

The Children Act 1989 will have a major impact when it is introduced five months from now, in October. It provides a proper framework to safeguard the child as well as the parents and will promote firm action to protect the child when necessary.

Does my hon. Friend agree that the Children Act recognises fully the importance of the role of parents?

The Children Act redresses the imbalance in terms of recognising the on-going responsibility of parents. Two new orders are the emergency protection order, which enables parents to return to court after 72 hours to put their case, and the child assessment order, which means that the child can be assessed without removing parental rights.

Is the Minister aware that there appears to be a deliberate campaign of misinformation in certain sections of the press about the role of social workers in child abuse cases? Will he take the opportunity of the implementation of the Act in October to launch a public information campaign, setting out the rights and duties of parents under the legislation and also the rights, responsibilities and duties of local authorities and the social workers whom they employ?

I certainly endorse the hon. Gentleman's point. However, the decisions that social workers must make are enormously complex. If social workers remove a child needlessly, they are castigated; but if they do not remove a child and it is abused, they are also castigated. Sometimes it appears that there is a ritual abuse of social workers.

Will my hon. Friend consider, when looking at the aftermath of child sex abuse cases in the past two years, giving child psychotherapists a primary responsibility for identifying whether a child should be taken into care? I ask that because, as my hon. Friend knows, the modern social worker is a generic animal and does not have the specific child care knowledge that the old-style children's officer used to have.

Skilled and professional workers should also know the limit of their knowledge and there are clearly times when they need to seek further expertise and advice. Our major implementation programme for the Children Act is unprecedented in child care. I recently announced a further package of initiatives, amounting to £1 million, to deal with various aspects of child abuse. One of those involves the treatment of victims of child abuse. The aspect that my hon. Friend indentifies is part and parcel of the matters on which we hope to make further progress.

I think that the Minister appreciates that there is a good deal more common ground on that issue than on many that come before the House. What action is being taken to remedy the acute shortage of qualified social workers to implement the most significant piece of child care legislation for the past 100 years? If 50 per cent. of local authorities are to implement the Act on the financial basis of cuts or no growth, how will they meet the strict new timetables laid down by the courts for the detailed and rigid assessments required, given that shortage? How will the social service departments avoid families becoming child abuse statistics if they do not have the resources to operate what must be the ultimate user-friendly service?

I endorse the hon. Gentleman's point about the spirit of co-operation that underlies the implementation of the Act. Because of the resource implications, this year local authorities, in their personal social services standard spending assessments, have seen an increase of 23·5 per cent., which is the biggest increase in money going into social services for 15 years. Moreover, there has been a 40 per cent. increase for social worker training, amounting to £50 million.

My hon. Friend will know that the Children Act arose as a direct result of the Cleveland child sex abuse scandal. How does she react to the fact that my constituents who were caught up in that scandal are still, seven months later, waiting for compensation? It should have been paid to them, but is being held up because of the solicitor acting on behalf of the local authority and the doctors involved, who caused the scandal in the first place.

My hon. Friend played a major role in drawing attention to the situation in Cleveland and championing the cause of his constituents. I am happy to report that when the social services inspectorate went back to Cleveland relatively recently, it was most impressed by the way in which lessons had been learned and the new procedures implemented. I have no information available on my hon. Friend's specific worry, but I shall take up the matter on his behalf.

To ask the Secretary of State for Health if he will make a statement on the future of the Mental Health Foundation of Mid Staffordshire national health service trust.

We have every confidence that this trust will continue to raise the quality of care available to its NHS patients.

Does the Minister agree that the only way to guarantee the highest quality of standards and services for people with mental illness is to ensure that the mental health services stay as an integral part of health and social care? We must not allow them to opt out, operate separately and sell their services to general practitioners and hospitals, thus providing a fragmented service that will allow patients to fall through the net.

I entirely agree with the hon. Lady that mental health services must be an integrated part of the national health service, which is where they remain when they are run by NHS trusts. I hoped that the hon. Lady would use the opportunity of her question this afternoon to welcome the fact that the trust has already employed 20 additional staff in the mental health services of Staffordshire since 1 April and is committed to a further 20 staff before the end of this year. I hoped that she might also welcome the commitment to quality of service by the trust which is shown by the introduction of patient questionnaires, regular surveys of long-stay patients and a medical audit, the setting of standards and by the facts that 90 per cent. of all staff have attended training on quality and public meetings are being held every two months. I should have thought that the hon. Lady would welcome at least some of those facts.

To ask the Secretary of State for Health if he will make a statement on the future of the Guy's and Lewisham national health service trust.

The long-term future of the Guy's and Lewisham national health service trust will ultimately be determined by the willingness of districts and GP's to send patients there.

Will the Secretary of State guarantee that no two-tier service will develop in Lewisham? Is he aware that the two fund-holding general practitioners from Bromley have applied to the trust for a contract that not only asks for accelerated waiting times but demands that all their patients are seen by locum consultants and senior registrars? Will he instruct the trust not to accept that contract, or does he believe that my constituents deserve a second-rate service?

I should have thought that the hon. Lady might welcome the new and better services that many of her constituents are receiving and would turn to the districts and say that they should match that performance in their contracts. It is a pity that she did not mention, for example, the new children's unit that is to be opened at Lewisham hospital this week to replace the 119-year-old unit at Sydenham hospital—perhaps she will be at its opening.

Does my right hon. Friend agree that it is dangerous, cynical, electioneering nonsense to talk about a two-tier system? Will my right hon. Friend make it 100 per cent. and unequivocally clear that the health service trusts are not opting out of the health service and are beholden not to big business, property developers or shareholders but to the best possible care of patients?

As my right hon. Friend the Prime Minister said, if they are opting out of anything, it is bureaucracy. As every doctor must have been trained in an independent, board-run hospital, it strikes me as ironic that so many of them seem to find the idea surprising.

Will the Secretary of State answer the question of my right hon. Friend the Member for Lewisham, Deptford (Ms. Ruddock)? Will there be queue-jumping at Guy's and Lewisham, which will mean that, instead of patients being treated according to clinical need, some patients will have to wait longer and be treated by more junior members of staff because a minority will be able to jump the queue? Is that the system that we shall see at Guy's and Lewisham?

The hon. Lady is confused. It is for Guy's and Lewisham, as a hospital trust, to set its proper priorities for clinical care. Those who are seeking better treatment for patients, whether they are districts or GP fund holders, are doing their best for their patients and should be encouraged to do so.

To ask the Secretary of State for Health what arrangements will ensure severely disabled people have control over their own personal assistance arrangements under the community care proposals.

Our guidance to local authorities emphasises that service users, including severely disabled people and their carers, should be involved as closely as possible in decisions about what services should be provided to them individually. Section 46 of the National Health Service and Community Care Act 1990 also requires that local authorities consult representatives of users and carers in preparing their community care plans.

Does my hon. Friend accept that when local authorities cannot provide the personal assistance that severely disabled people need if they are to live independent lives in the community, the present practice is that those local authorities can make cash payments to allow disabled people to buy in those services—and that that should be allowed to continue? Does she recall that she and other Ministers and the Audit Commission supported that idea in principle, and will she look for a way of putting it on a statutory basis?

As my hon. Friend is well aware, it has not been possible to find a way to break the long-standing tradition in which local authority social service departments provide services and social security departments provide financial resources. As my hon. Friend knows, I am most sympathetic to the approach that says that those who are severely disabled should feel as far as possible in control of their destiny and of the care that they receive. In our practice guidance we shall emphasise that as strongly as we can.

Does the hon. Lady accept that for such disabled people to have a real choice they need consultation and representation of the sort embodied in the Disabled Persons (Services, Consultation and Representation) Act 1986? The section to which she referred does not go anything like as far as that Act in ensuring that disabled people's voices are adequately heard so as to ensure valid choice for them.

I do not accept that. I refer the hon. Gentleman to the debate initiated by the hon. Member for Monklands, West (Mr. Clarke) in which many of these issues were discussed. Since the passage of the Disabled Persons (Services, Consultation and Representation) Act, care for and understanding of disabled people have moved forward at a great pace and the philosophy of "Does he take sugar?" is, I hope, a thing of the past. The National Health Service and Community Care Act overtakes the Disabled Persons (Services, Consultation and Representation) Act; but we shall of course keep the matter under review once the formal requirements to consult the users and the carers on plans and assessments have been implemented. The local authority associations have been given a clear commitment, as have others concerned with the disabled, that we shall continue to review the matter once community care is fully implemented.

Is the hon. Lady aware that the fundamental issue here is one of human dignity and independent living for disabled people? How does she respond to the letter in The Times from her hon. Friend the Member for Mid-Kent (Mr. Rowe), published last Thursday, about the need to end the legal impasse? Is she aware of the widely held view among disabled people, as reported by the Spinal Injuries Association, that the Government's attitude on this issue is "patronising and ill conceived"? Will she act now to give them both choice and the fullest possible control over their own lives?

I very much hope that all the energy and commitment of the many organisations concerned with disabled people will be transformed into working with local authorities and their community care plans. Local authorities must have those plans drawn up within the year. They have to consult users and carers in that work, and I believe that the special protected position of disabled people under the Act should be broadened to ensure that community care moves forward as fast as possible.

To ask the Secretary of State for Health what research has been conducted on the relationship between the length of national health service waiting lists and the availability of private practice.

To ask the Secretary of State for Health if he will initiate a study into the effects of the availability of private practice on national health service waiting lists.

We have not conducted, nor do we plan to conduct, any research into the relationship between private practice and national health service waiting lists. However, we are determined to tackle long waiting times for NHS treatment. The NHS management executive is agreeing tough targets with all 14 regional health authorities for substantial reductions, by March 1992, in the numbers waiting over one year for treatment.

Is not it a disgrace that, three months after John Yates, the Government's former waiting list expert, drew attention to the fact that private practice by national health service consultants may be leading to longer waiting lists for NHS patients, the Government have done nothing about it? The Secretary of State's reply is just not good enough. Will he assure the House that an immediate investigation will be carried out into this matter, or does he simply intend to expand his party's two-tier health service, which means priority for private patients and longer waiting lists for national health service patients?

I do not think that the hon. Gentleman has exactly and correctly reported Mr. Yates's views. If the hon. Gentleman will produce evidence to back what he says, I shall look into it. The hon. Gentleman presents yet a further argument in favour of national health service trusts. Those trusts will hold the contracts for their consultants, and it will be open to them to negotiate with their consultants if they wish to see them carrying out more national health service work.

Given the evidence of Mr. John Yates to the Select Committee, does not the Minister recognise the need for a study of this matter and the possible dire consequences to the health service if it is ignored?

I think that my previous reply answers the hon. Gentleman's question. If the baying of Opposition Members over the issue of independent practice by doctors were drawn to the attention of the British Medical Association, it might dampen the association's enthusiasm for anything that might lead to a Labour Government.

Is my right hon. Friend aware that whenever the Public Accounts Committee has looked at any alleged negative relationship it has found none? Will my right hon. Friend ensure that the whole issue of waiting lists is simplifed so that health authorities who remove people from the waiting lists are paid after they have performed the required service?

I confirm that my hon. Friend is right. There has never been any evidence to show what has been alleged. There is unfair reporting of the matter. One of the newspapers that supports the Opposition, the Daily Mirror, reports another of Mr. Yates's ideas, which is to give incentives to doctors who do well in reducing waiting lists. However, the Daily Mirror reports that in most unfair terms as being a dreadful thing to do. I am not sure whether the Labour party is in favour of Mr. Yates or against him.

Will my right hon. Friend not be drawn along lines that confuse the issue but confirm that the national health service is what it says it is, what it has always been and what it always will be—a service that is available when needed and free at the point of need?

I have no difficulty in fully endorsing that. In response to these questions, I re-endorse an element of the policy of the national health service's founding Minister, Mr. Aneurin Bevan, who made a historic compromise with consultants when he allowed them independent practice in NHS hospitals.

Is the Secretary of State aware that the BMA does not represent consultants? If he wants to know what consultants think, he should talk to their representative groups. Would he ask them to explain why, over a recent holiday weekend, the trust in my area simply stopped taking in patients because it did not have a senior registrar available to do the work?

I think that Mr. John Chawner would be confused to be described as not representing consultants. He regards that as his job and he certainly represented them when he saw me a few days ago. I am willing to admit that, in the few weeks in which they have been in existence, the trusts have not solved all the problems of the national health service. There are still problems, but I assure the hon. Lady that the management delivered by her NHS trust will be much better than the traditional management, which created these problems in the first place.

To ask the Secretary of State for Health what has been the real growth in capital spending in the national health service since 1979.

Gross capital expenditure in the national health service in England has grown by 62 per cent. in real terms since 1978–79.

I am grateful to my hon. Friend for that answer. Will he confirm that it includes more than £40 million-worth of new capital investment in the North Hertfordshire district health authority area? Those projects are well appreciated by those who live in the areas concerned, especially as the projects were cancelled by the Labour Government.

My hon. Friend is right in his figures and in drawing a favourable comparison between our record and that of our predecessors. In the past 12 years, capital investment has increased by 62 per cent. in real terms while under the Labour Government it decreased by 16 per cent. in five years.

Does the Minister agree, that as he knows all too well, in the St. Helen's and Knowsley hospitals area investigations show that capital and other funding has always been undercut? Now that we have hospital trusts—both hospitals have opted out—are we to understand that the hospitals will get no more capital and that there is no hope of our ever having the capital that we should have had over the past 15 years?

The hon. Gentleman has not quite caught up with the Leader of the Opposition. The funding argument is over. The Labour party is clearly on the record as saying that an incoming Labour Government would have no new money for the national health service. The question that the hon. Gentleman asked me is one that he should put equally to the Opposition Front Bench.

Does my hon. Friend agree that while, we welcome the additional resources that have been made available in the eastern region, in formulating hospital policy big is not necessarily beautiful? I cite, for example, the unsatisfactory proposal to move the world famous Papworth hospital into the already over-large Addenbrooke's hospital.

I entirely agree with my hon. Friend that big is not necessarily beautiful. In designing future NHS provision, it is important to ensure that it meets the identified needs of patients. That is the priority that we have established through the establishment of the purchaser-provider split. We have ensured that it is the principal responsibility of the new health authorities.

To ask the Secretary of State for Health when he last met representatives of local authorities to discuss the implementation of the National Health Service and Community Care Act 1990.

Ministers regularly meet representatives of local authority associations to discuss a range of matters, including community care implementation. They last met them on 16 April.

Does the Minister recall telling the Leonard Cheshire Foundation conference recently that caring and costing are related? If so, what has she told local authorities about community care? More than half the local authorities are having to make cuts in their community service provision and in their grants to voluntary bodies. Those cuts are necessary if authorities are to fulfil their statutory obligation to implement their part of the care in the community policy.

I was honoured to speak at the annual general meeting of the Leonard Cheshire Foundation, which provided an excellent example of care in the community. Perhaps those who were wasting money on the £1·5 million National and Local Government Officers Association's advertisement last week should have paid attention to it. In talking with local authority associations, we are discussing the 23·5 per cent. increase for social services this year, which is in part the result of phase 1 of the community care programme. We have taken the unprecedented step of providing specific grants for voluntary organisations which provide drug and alcohol support as well as introducing a specific grant for the mentally ill. In short, the meetings with local authority associations integrate caring and costing. We make it clear that the Government will support community care and we look to local authorities diligently to implement the policy.

Has the Minister grasped the sharp increase in charges that social services authorities are having to make for disabled and elderly people? Is he aware that the average rise in charges for home helps is one third, which is four times the rate of inflation? How many elderly people does the Minister know whose benefit has increased by a third in the past year? Does it not make a mockery of care in the community if elderly and disabled people have to pay for the care that they need?

What is clear is that local authorities need to think through their charging policies. As hon. Members will know, Derbyshire, for instance, provides one in three of its elderly residents with a home help, and charges nothing. There has been a dramatic expansion in community services, with an increase of 30 per cent. in the number of day centres for the elderly, an increase of 25 per cent. in the meals on wheels service and a 27 per cent. increase in the number of home helps.

When the Minister comes out with statements like that about the reality of community care, she seems to pay no attention to the findings of the Radio 4 programme "You and Yours", on which she was interviewed last week. The programme carried out an in-depth analysis of the subject, across the whole country. Does the Minister accept that—according to the clear evidence that emerged from that process, and the direct feedback from those who were involved and consulted, community care is in a catastrophic state because of underfunding and because of the delays to which it has been subjected? Anyone who has talked to those in the local social services departments will inform hon. Members on both sides of the House of that.

As I hope that all hon. Members will agree, the key issue is that the challenge of caring in the community affects all our constituents as demographic factors change and expectations rise. We must harness the good will of the community to meet those care needs, to provide carers with practical support and to ensure that our provision is truly user-led rather than producer-driven.

To ask the Secretary of State for Health how many doctors were working in the national health service in 1979 and in 1990.

The number of doctors in the national health service in England has risen from 61,554 in 1979 to 72,446 in 1989.

I thank my right hon. Friend for that reply. Does he agree that it represents a record of achievement, under a Conservative Government, of which we should be proud? More doctors are spending more time with their patients, and there are fewer of those patients.

My hon. Friend is right to pay tribute to the Government for the major increase in the number of medical and clinical personnel in the NHS. That is reflected in the many more treatments that have been afforded to our people.

Does the Secretary of State accept that members of the British Medical Association in Bradford voted by a large majority against the establishment of the Bradford health trust? Does he agree that the cuts announced so far—a £7 million cut and 300 redundancies—have done nothing to allay those doctors' anxiety?

The Select Committee needs no encouragement from me to carry out its questioning, and I am sure that it will do so excellently.

Does my right hon. Friend agree that, under the old arrangements, a significant and regrettable minority of GPs treated their patients with less than the full care that we would expect and that the current much more positive response from GPs is already being manifested under our new arrangements?

I think that they were always a very small minority. The new GP contract, which is delivering major improvements in services to all our patients in this country, shows that GPs are providing ever better service. It is characteristic of the Labour party, I am afraid, to oppose the new GP contract.

To ask the Secretary of State for Health what advice he is giving the Northern region health authority in respect of future applications for national health service trust status.

We have made it clear that trust status is our management model of choice throughout the NHS.

Is the Minister aware that there is deep resentment and anxiety in the Northern region about the Government's pushing hospitals to go for opted-out status? I am particularly concerned about the financial viability of the north-west Durham health application. Will he guarantee today that the business plans in connection with that application and others will be published so that people who now feel anxiety will be able to see for themselves precisely what the future offers?

My right hon. Friend the Secretary of State has already dealt with the question of the publication of business plans. I remind the hon. Lady that NHS trusts have an obligation to publish reports to the local public. That obligation is entirely new—it was never in the traditional model of management of the national health service.

Is not the situation in inner London rather different from that in the Northern region? In inner London there are 82 consultants and 420 beds per 100,000 population, whereas in the Northern region there are only 26 consultants and 260 beds per 100,000. Does that not show that in the past 10 years the Government, through the 39 major capital schemes in our region, have shown an unequalled commitment to the improvement of the health service in the Northern region, which is now being demonstrated by the number of local hospitals that wish to take on trust status so as better to serve their local population?

My hon. Friend is absolutely right to draw attention to the difference between experience in London and that in the Northern region. He may be interested to know that experience so far of Northern region trusts is that the three existing trusts, in the six weeks that they have been in existence, have already created 11 new consultant posts. One might have hoped that the hon. Member for Durham, North-West (Ms. Armstrong) would welcome that.

To ask the Secretary of State for Health if he will gather information on the experience of national health service trusts, with particular reference to staffing and finance.

Trusts are required to publish annual accounts and reports about their work. They are also required to submit business plans to the Department. They are free, however, to determine the number of staff they employ and to set the terms and conditions they offer them. We are confident that trusts will deliver real benefits to their local communities.

Would the hon. Lady care to estimate how long it will be before she receives the first application from the directors of an NHS trust to go completely private? Will she give an absolute assurance that if she is still the Minister and the present Government are still in power they will do absolutely nothing to enable NHS trusts to become completely private hospitals?

I find it positively incredible that a member of a party that cut resources for the health service in real terms, cut the capital building programme and cut nurses' pay, should have the outrageous cheek to ask a question of that sort. I can give the hon. Gentleman a clear assurance that NHS trusts are intended to ensure better management of the national health service for better patient care. That is what we have invested in the health service for, that is why we have increased the number of staff, that is why we have improved the training, and that is why we are now improving the management structure—to provide better patient care. There is no hidden agenda; there is no intention whatsoever that NHS trusts should do anything other than remain part of the national health service.

Is it not a fact that the national health service trusts came into operation just six weeks ago and that, while of course it would be perfectly valid in a year or two to evaluate how they are working out in practice, the present campaign by the Labour party against trusts, when they have barely started, is completely phoney?

As my hon. Friend will know, the Opposition, having so singularly failed to deliver when they were in control of the health service, now indulge in a policy of scaring rather than caring. We have seen it all before. We had it with general practitioner contracts and with the indicative list, and now we have it with trusts. We on the Conservative Benches know that we are right to be carrying forward between management plans for the health service.

Will the Minister confirm that she has again appointed Coopers and Lybrand Deloitte to study the information that she is receiving from the second wave? Will she this time allow the public who use the hospitals to see the report? Does she recognise that after the cuts at Guy's, Leeds and Bradford, the public this time will not fall for promises? The public will want to see the business plans to judge for themselves whether this time the promises about trusts are any less empty than they were last time.

What is clear is that we have revolutionised the amount of information that is available about the way in which the health service is managed. We shall not make public the report from Coopers and Lybrand Deloitte. [HON. MEMBERS: "Why not?"] It will be one of the many reports to the Secretary of State giving him the information on which to base his decision whether to establish a trust, the purpose of which is to satisfy himself that better patient care will be available. That will also be safeguarded by the contract with the district health authority, which is the champion of local people and improved services.

To ask the Prime Minister if he will list his official engagements for Tuesday 14 May.

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.

Will my right hon. Friend confirm that he has excellent and detailed plans to increase spending on public services by £38 billion in the next three years? What would be the effect of substituting an uncertain £20 billion along with socialist cuts and taxes on earnings?

If a £20 billion increase were substituted for our present plans, it would certainly mean a substantial reduction in services across the board, no doubt including the health service as well. On the other hand, if there is to be £20 billion in addition to the spending plans that we have proposed, it would undoubtedly lead to large and significant tax increases across the board.

Does the Prime Minister think that any citizens' charter should include giving people the right to vote on whether they want their local hospitals to opt out?

In view of what the right hon. Gentleman has previously said, I am very surprised that he has so little faith in the medical people who make those decisions.

Even the Prime Minister must know that the "medical people", as he refers to them, whenever they have voted, have voted by majorities in excess of 80 per cent. against opt-out. [Interruption.] I will provide a list later.

Why does the right hon. Gentleman always run away from the facts? He is wrong on the subject of medical people and, as for trusting the people, we have trusted the people to make decisions more in the past 10 years than any Labour Government ever would.

Will the Prime Minister now answer my question? Will he give people the right to vote on whether hospitals in their localities should opt out?

rose—[Interruption.]

Order. It is no use hon. Members' shouting, "Answer" unless they give the Prime Minister a chance to do so.

What a remarkable question from the leader of a party whose education spokesman would take away the right of parents to decide what nature of schools their children could go to.

To people in unskilled work, wages or a salary of £20,000 a year may seem very good pay indeed, but does my right hon. Friend feel that a level of pay of £20,000 a year makes a person rich—rich enough to be taxed at the horrendous levels now being spoken of by the Labour party?

Only a genuine Leveller would think that £20,000 a year was rich these days. Certainly, no doctors, police constables, police sergeants, fire sergeants and others would think that. The reality is that average earnings and take-home pay have risen substantially in recent years. Only the Labour party could produce taxation policies to penalise people on modest incomes. Were it to implement all its plans it would be penalising not only people on modest and average incomes but every taxpayer.

To ask the Prime Minister if he will list his official engagements for Tuesday 14 May.

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

As the Prime Minister has demonstrated his intention to hold the 1992 European summit in Edinburgh, would he also accept that Scotland's international diplomatic role could best be served not by inviting Europe to our capital city for a few days every other year but by enabling Scotland to play her full international role as a member of the European Community in her own right 365 days a year, especially against a background in which the people of Scotland have shown that independence is their preferred constitutional choice?

Scotland has played a very honourable role in international affairs as part of the United Kingdom for a long time and it will continue to do so in that fashion. I am glad that the hon. Lady welcomes the fact that the European Council will be meeting in Edinburgh. It think that the people of all Scotland, but especially Edinburgh, will welcome that too.

Will my right hon. Friend confirm that the Government intend to raise £5 billion per year from the proceeds of privatisation in the next Parliament? Will he also confirm that if that revenue were not forthcoming, it would be necessary either to reduce public services dramatically or to raise taxes and to increase public borrowing to an unacceptable level?

My hon. Friend is entirely right. It would seem from what the Leader of the Opposition has said that the Labour party is planning either dramatically to increase taxation or dramatically to cut spending on public services. Privatisation has not only raised significant resources to liquidate parts of the national debt but has dramatically improved the performance of the companies concerned. We shall continue with policies of privatisation. I think that that will be much more welcome to people than increasing borrowing on the scale that a Labour Government would envisage and increasing taxation, which is what Labour has always delivered.

To ask the Prime Minister if he will list his official engagements for Tuesday 14 May.

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

To ensure that a citizens' charter for the health service has real meaning for the people in my constituency, will the Prime Minister confirm that as 100,000 people have signed a petition to protest at the proposed closure of Withington hospital and its maternity unit, and as 3,000 people joined hands around the two-mile perimeter to protest about the plan, such overwhelming support will mean that citizens have the right to retain their local hospital and that the Government have a right and duty to honour their views?

As the hon. Gentleman knows, matters of that sort are dealt with in the first instance by the health authority, and I think it is better that they should be. What I can tell the hon. Gentleman about the citizens' charter—an idea that I first began to consider and to speak publicly about in 1987—is that it will provide far greater redress for the citizen than ever before.

Is it not becoming clearer day by day that the Labour party is coming out in its true colours as the party of high spending and high taxation—

Order. The right hon. Gentleman must ask a question about the Prime Minister's responsibility.

Did not my right hon. Friend reflect when he got up this morning that the Labour party is coming out in its true colours—

Order. That is no good.

To ask the Prime Minister when he next expects to pay an official visit to the United Nations.

I have at present no plans to do so. However, I am in regular contact with the secretary-general.

In view of the withdrawal of the Valiant Churchill class of nuclear submarines due to dangerous defects in their nuclear reactors, would it not be prudent for the Prime Minister to withdraw all Polaris nuclear submarines, which have identical defects in their nuclear reactors? At the same time, he could cancel the Trident programme and announce that his Government are supporting the United Nations—[Interruption.]

Order. Hon. Members should give the hon. Gentleman a chance to get to a conclusion.

The Prime Minister could announce that his Government were supporting the United Nations nuclear non-proliferation treaty; the 141 states which have signed that treaty have pledged not to deploy or manufacture nuclear weapons.

Briefly, please.

Billions of pounds could then be released for the national health service in this country and for the millions of poor in other countries throughout the world.

Someone spoke a moment ago about the true face of the Labour party. I think that we have just heard it. I happen to be in favour of our maintaining a nuclear defence. That will be our position in the future. I am interested to learn from what the hon. Gentleman has said that that may not be the position of the Opposition.

To ask the Prime Minister if he will list his official engagements for Tuesday 14 May.

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

Does my right hon. Friend agree that education, and particularly the quality of that education, are paramount in many people's minds? Is he aware that in Birmingham we have excellent grant-maintained grammar schools which are under threat from the local Labour council, which intends to strangle them to death so that there is no choice for the people of Birmingham, despite 96 per cent. of them saying that they want their grammar schools maintained? Will my right hon. Friend join me in supporting educational excellence.

I was not aware of that proposal, but I am unsurprised to hear that that is the view of the Labour local authority; it clearly has no concern for the views of parents about education—a point which the Leader of the Opposition neglected to mention. As a general principle, I agree with my hon. Friend that the Labour party opposes choice on assisted places, on city technology colleges and on grammar schools. Its top priority on day one, as the hon. Member for Blackburn (Mr. Straw) said, would be to take away parents' choice to keep their schools independent of council control.

As the Prime Minister has registered that some in his party regard the proposals put forward by our European partners next week on monetary union as a fudge, and as one of his Ministers has said that they are a fraud, although many others will see them as Britain's last opportunity to be at the heart of Europe rather than its periphery, will he now tell us his view of the proposals? Are they a fudge, a fraud or an opportunity not to be missed?

We are at a very early stage in the negotiations on economic and monetary union and on political union. As to the proposals to which the right hon. Gentleman referred, my right hon. Friend the Chancellor told the House in January that

"the Government have made it plain to our European partners that we cannot accept any changes to the treaty of Rome which would bind us to a single currency or a single monetary policy without a separate decision by the United Kingdom Government and Parliament."—[Official Report, 24 January 1991; Vol. 184, c. 470.]

To ask the Prime Minister if he will list his official engagements for Tuesday 14 May.

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

Is my right hon. Friend aware that the evidence is that, in local government, competitive tendering has given the public good value for money? Does not that mean that we should have similar policies throughout the public sector, including the national health service?

My hon. Friend has considerable knowledge of the health service and he is, of course, entirely right. Abolishing competitive tendering for support services would threaten the loss of the savings of £150 million a year that have been achieved in the national health service thus far. Opposition to those improvements and to efficiency improvements worth £400 million could only remove more than £500 million from the health service, year after year after year. That is the policy of the Opposition, but not of the Government.

To ask the Prime Minister if he will list his official engagements for Tuesday 14 May.

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

Does the right hon. Gentleman recollect that, prior to the last election, the Government gave a categorical assurance that if re-elected they would not increase VAT? Bearing in mind that, having been re-elected, the Government doubled VAT, will the Prime Minister invite the electorate to believe future election promises? If so, can he now say categorically whether the Conservative party, if re-elected, will increase VAT further?

Characteristically, the right hon. and learned Gentleman is telling only half the story. He utterly neglects to mention the fact that there was precisely corresponding reduction in local tax by way of the reduction in the community charge.

With the leave of the House, I will put together the two motions relating to statutory instruments.