To ask the Secretary of State for Health if he will make a statement on the provision of training for local authority staff in preparation for their responsibilities under the National Health Service and Community Care Act 1990.

Training for local authority staff is the responsibility of the employing authority. Our specific grant provision to local authorities for the training support programme this year was increased by 25 per cent. to £25 million. In addition, local authorities should be spending at least £10 million of their own resources on training.

Is the Minister aware that many local authorities, including my own in Gateshead, are expressing considerable concern that not nearly enough funds will be available to provide the training that will have to be introduced if community care is to be implemented properly? Will she have urgent discussions with the local authorities on this matter and assure us that the necessary steps will be taken to ensure that recruitment is at its proper level so that community care can become a reality instead of the pretence that it seems to be at the moment?

I assure the hon. Lady that we have had close discussions on the implementation of community care. Only last week my right hon. Friend the Secretary of State introduced a check list to ensure that all local authorities and health authorities are properly prepared for full implementation. Central Government have been playing their part. In the hon. Lady's constituency, there has been a 50 per cent. increase in the amount of money that is available for training social workers and I am pleased that that is being used to train three times as many social and other community care workers this year.

Will my hon. Friend make sure that local authority workers are trained to make the best use of voluntary and independent groups? Local authorities should not have a monopoly on community care.

This is always a difficult issue for the Labour party, given that one third of its Members are sponsored by the health unions. The Conservative party has traditionally had a high regard for the role of the voluntary sector. We envisage the local authorities being enablers and facilitators in a close partnership with the voluntary sector. That is often an extremely productive way of providing high-quality services.

Leaving the party politics to one side for a moment, may I ask whether the Minister agrees that local authorities welcome the addition to the training programme? There is no question about that. However, exactly when did the hon. Lady warn the local authorities about the full consequences of the reforms for elderly and disabled people? Does she now appreciate that duties that were once the sole province of the district nurse are now being carried out by home carers? I refer to bathing, caring for the terminally ill at home and the application of medication. That work is now being placed on local authority social service departments and on the home care service. Will the Minister explain why those tasks have been transferred from the district health authorities to the social services departments, if not for budgetary reasons?

What will be the full consequences—[HoN. MEMBERS: "Come on!"] Oh yes. These are not party political points; I apologise for that. Where was it was ever specified in guidance from the Department or in regulations that the local authorities had been warned about all the consequences of national health service reforms?

The hon. Gentleman should address the content of the original Griffiths report on community care. The distinction between health care and social care is one of long standing in the provision of services. To undertake the tasks for which they are responsible, local authorities have this year been given the largest increase for 15 years in the amount that we think that they should spend. They have been given a 23.5 per cent. increase in the amount available for spending. Certainly, the implementation of community care depends on close, effective working relationships between family health service authorities, district health authorities and local authority social services departments. I urge the hon. Gentleman to look at the important check list launched by my right hon. Friend the Secretary of State last week. It addresses precisely the need to ensure that the frail and vulnerable receive a seamless service and do not fall down the gaps between different types of provision.

My hon. Friend will be aware of how welcome the extra money has been. Can she give us an assurance that the training that is provided is consistent with national vocational qualifications? Can she also confirm that her Department is looking forward to the time when it will be easy to interchange social workers between Britain and other European Community countries?

Once again, my hon. Friend identifies a matter of great importance. The establishment of national vocational qualifications within social services and health services offers additional flexibility in the provision of care. There has been a substantial—25 per cent.—increase in the amount of money available to the training support programme. Certainly, some of that is being used to resolve the question of vocational qualifications. The subject of interchangeability of qualifications with others in the European Community is one on which I have frequent discussions with members of the British Association of Social Workers and others who represent social workers' interests.

To ask the Secretary of State for Health how much has been spent on special care baby units in the NHS in each of the last two years.

Specific information on expenditure on special care baby units is not collected centrally. In 1988–89 and 1989–90—the latest years for which information is available—total estimated expenditure on maternity and paediatric services was £1,192 million and £1,251 million.

Will the Minister persuade the Bradford hospital trust to stop the planned closure of the special care baby unit at St. Luke's hospital in Bradford? If the unit closes, more sick babies will have to be transported across Bradford city centre, or even treated in Leeds or as far away as Manchester. Will she also press the trust to review the centralisation of maternity services which would result in 6,000 babies being born each year under one roof? Lastly, will she persuade the Secretary of State for Health to stop being a wally and accusing me of scaremongering about redundancies as we now know that in Bradford there will be 250 redundancies by next April, rather than 300 over the next three years?

The hon. Gentleman is showing the thinking of neanderthal man. He takes an unreconstructed approach to how we can improve the perinatal mortality figures in Bradford. We all agree that the figures need to be improved, but we shall not do so through the reactionary holding on to jobs that is so typical of union-sponsored Labour Members of Parliament. As ever, the Transport and General Workers Union is holding on to its own. The hon. Gentleman should think of his constituents, not of his trade union. He should think of the health of the nation and the strategy for health. In his area the general practitioner list size has fallen by 500 over the past 10 years. The hon. Gentleman should look to health visitors, midwives and community services, not merely to hospital provision. The role of the district and its purchasing function is to make sure that the figures, about which we all share concern, are brought down.

How many low birthweight babies now survive the most crucial first four weeks of their life?

Ninety per cent. of low birthweight babies now survive their first four weeks of life. We have had the most dramatic improvement in perinatal mortality figures. Indeed, we beat the World Health Organisation targets for Europe and, of course, the general targets, too. We now wish to make sure that some of the regional variations are dealt with better because although in some parts of the country the figures are excellent, others lag behind. That is the result of a complex series of matters.

To ask the Secretary of State for Health if he will make a statement on his projections for the future activity levels of NHS trusts.

I expect further significant growth in the activity of national health service trusts roughly in line with increased activity across the NHS as a whole.

Does the Secretary of State realise that those who run, work in and use the national health service see no benefit from the introduction of hospital trusts? Does he further realise that those who work in the NHS consider that the job losses that are occurring as a result of the introduction of hospital trusts will have a direct bearing on patient care to the detriment of the service? Does the right hon. Gentleman consider all that to have been a satisfactory outcome of the implementation of the Government's hospital trust policy? Does he further consider—[Interruption.]

Order. The hon. Member is about to ask a third question. I think that is enough.

The hon. Gentleman is completely wrong. More than 100 new applicants for trusts are coming along, supported by many thousands of senior clinicians and managers in the health service. My constituents are served well by a trust and I know the workings of the trust well. The scares that have been handed to the hon. Gentleman to get him to join in our questions on the subject today are quite off the beam.

I thank my right hon. Friend for deciding that NHS trusts should make public their business plans. That decision will be widely welcomed. Will he give an assurance that the specialist department in the Department of Health will scrutinise more adequately the financial plans of potential trusts and ensure that their projections of income and expenditure are accurate and are based on fact, not on assumption?

Detailed projections for a year ahead are always likely to be false, in some cases because of the allocations that are made later in the year. So there is no way in which those making proposals in July and August can exactly describe the financial situation the following year. However, I agree with my hon. Friend that we must examine all applications with great care, as we did last year.

As there was no reference in the Conservative manifesto to setting up trust hospitals and as the results of every local referendum on the issue have been overwhelmingly in one direction—against them—although they have been ignored by the right hon. Gentleman, does he agree that when it comes to phase 2 of the trusts, it would be sensible to learn the lessons of the first wave and allow the matter to be put to the test at the next general election, before any more trust hospitals are established?

The hon. Gentleman's difficulty is that throughout the country local Liberal parties have taken a completely different line. That is not surprising, as many Liberals have supported trusts. The hon. Gentleman tries to maintain a uniformly negative position from here, even though that position is not supported by many of his party's members.

Will my right hon. Friend confirm that when taking a view of trust applications, he will not always be looking merely at trusts that are currently in a good financial state but will encourage others to take NHS trust status to improve their financial position in the future?

My hon. Friend puts his finger on an important point. The improved management that we obtain from NHS trusts is necessary in places where there may be problems. That is why I am delighted with the improved management at, for example, Guy's and Lewisham, because everybody knew that for many years there were problems there.

Further to the point of the hon. Member for Macclesfield (Mr. Winterton), does the right hon. Gentleman recall that a surplus was forecast when he approved the application from Bradford? By last month Bradford was forecasting a deficit and by last week it had announced the closure of 13 wards, including the special care unit to which my hon. Friend the Member for Bradford, West (Mr. Madden) referred. Why were none of those service closures included in the consultation document published less than a year ago—or was that also one of the biggest lies since the ancient Greeks? If the Minister did not know when he approved that application that approving Bradford as a trust would lead to those closures, will he now halt the second wave of opt-outs until he can tell us what went wrong with the first wave?

I liked the word "also". If the hon. Gentleman will think about the implication of his words, he will realise that he has just acknowledged that what he stated in his leaflets is untrue—as I think he very well knows. I am sure that the hon. Gentleman has studied the report of the Select Committee, which discussed these matters more seriously than the hon. Gentleman has done today. It is obvious that ahead of the allocations produced last December, it was impossible to produce a detailed cash flow for a hospital for the next year. What I had to adjudge—as I shall have to do again in respect of the second wave—was whether the management were capable of dealing with the problems in the hospital. Labour is getting wholly left behind on this, as on other things.

There will be a major second and third wave of trusts and that will be the pattern of hospital management for the future.

To ask the Secretary of State for Health if he plans to announce the inclusion of further nursing colleges for participation in Project 2000.

We made £71 million available for Project 2000 in 1991–92 and have already agreed to implementation in a further 14 colleges of nursing this year. The Project 2000 implementation group will be meeting early next month to advise me on the allocation of the balance of funding available and I shall make an announcement as soon as possible thereafter.

Although Wolverhampton will not, unfortunately, be getting a child support agency, because it does not have an appropriate building ready, my hon. Friend will know—because she had the honour of opening it—that it has a first-class nursing college, the United Midlands college of nursing and midwifery. My hon. Friend will be aware of Wolverhampton's disappointment that it has not yet been included in Project 2000. Now that there is more money in the kitty, can my hon. Friend guarantee that the United Midlands college will lbe carefully considered on its merits so that, if it is successful, it can give more representation to Project 2000 in the black country?

My hon. Friend is a great champion of that college and I much appreciated the opportunity to open it. This year, nearly £3.5 million is being spent on implementing Project 2000 in my hon. Friend's region. We are looking carefully at all the available projects and I give my hon. Friend a clear assurance that the United Midlands college will be given urgent consideration.

Is the Minister undertaking arty analysis to ensure that an adequate number of bridging courses are available to those who wish to enhance their qualifications? Will she ensure that such courses are evenly spread throughout the country?

One requirement of Project 2000 is that arrangements are made for enrolled nurses to improve their qualifications. We need to ensure that nurses at every level of qualification have a chance to improve and to continue their training. We spend in the region of £770 million on nurse training and we want it to develop across the board.

To ask the Secretary of State Health if he will make a statement on the progress of GP fundholding.

As the House will know, more than 1,700 general practitioners are voluntarily taking part in the fundholding scheme, which in its first year already covers 7–5 per cent. of the population of England. I am sure that my hon. Friend will join me in welcoming the agreement reached with the representatives of the medical profession on joint guidance for hospital consultants on GP fundholding which I announced last Tuesday.

Is my right hon. Friend aware that my constituency includes one of the GP fundholders to which he refers? That practice recently began hiring a consultant —paid for out of NHS funds—to ensure that patients are seen within one month, rather than have to wait for up to a year, as they previously did after being referred to Oldchurch hospital in Romford. Will my hon. Friend congratulate that practice on its initiative and acknowledge that it makes a better use of funds, gives a faster and better deal to the patient and reduces hospital waiting lists?

I am delighted to congratulate the practice to which my hon. Friend refers. It is just one example of how GP fundholders throughout the country are showing how to make better use of the money for patients. They are showing also how the NHS, which already does extremely well for its patients, can do even better if we can improve on devolving money to where decisions should be taken.

Will the Secretary of State take this opportunity to explain the claim that he made on the record that patients of fundholders bring new money with them? Will he confirm that every penny in GPs' budgets has been deducted from health authorities' budgets? Is not it a confidence trick to pretend that the same money becomes new money when laundered via GPs? He told us that 40 per cent. of GPs are expected to become fundholders. How will any number of pilot projects help health managers to plan for local needs with 40 per cent. less money in their budgets?

I am glad that the hon. Gentleman, who has been rather left behind in these matters, is catching up. It is perfectly clear that all NHS money comes from taxpayers. If the hon. Gentleman has just discovered that, it is wonderful. We have allocated some of that money to GP fundholders through the regional mechanisms available to us. Every year, we win new money for the health service and I hope that we shall do so again. We have a much better record than the Labour party on that.

On the hon. Gentleman's second point, it is perfectly clear that the close working relationship between GPs and districts can be developed further. I am looking at new ways of making that co-operation even more practical and efficient.

To ask the Secretary of State for Health what are the total savings from privatisation of ancillary services for the last 10 years.

Total savings from competitive tendering in England since 1984–85 now amount to £126 million a year.

I thank my hon. Friend for that reply. Does he agree that £126 million would buy one new hospital a year, 45,000 hip operations or 145,000 cataract operations? Would not the Labour party hand that money back to COHSE and NUPE? Should not people tell their grandchildren what it was like under Labour in 1978, when cancer patients who were dying were not allowed admission for treatment? Would not it be a good idea if they took note of the fact that the health service would be a hell service if it were coupled with the name of the hon. Member for Livingston (Mr. Cook)?

My hon. Friend is on to a good point. The Labour party is bound by two commitments: first, to abolish competitive tendering, which will cost £126 million; and, secondly, that no more money should be available to the health service. Labour Members must explain to the patients whose treatment would not be possible, despite the fact that that money is being provided to the health service, why they should wait so that the Labour party can discharge its pledges to the trade union movement.

Will the Minister give us the full picture on competitive tendering? What is it costing the Government in terms of social security payments to low-paid national health service workers because private contractors have driven wages down to poverty levels? How many NHS workers are now forced to take on two jobs to make ends meet? Will the Minister also explain the appalling standards of cleanliness in hospital wards because of private contracting?

What I will do is tell the House about the attitude of the general secretary of COHSE, Mr. Hector MacKenzie. He says:

"Success depends on the willingness of members …to push for a health service that acts in the interests of its staff."

The hon. Member for Livingston (Mr. Cook) was at the COHSE conference at the weekend. I hope that he took the opportunity to dissociate the Labour party from those sentiments.

Will my hon. Friend confirm whether competitive tendering is practised by the NHS in Merseyside?

My hon. Friend is on to an important point. Competitive tendering is practised by the NHS in Merseyside, which is clocking up savings of £6 million a year as a result. That is freeing resources which allows Merseyside to have a waiting list record that is second to none. If every other local service in Merseyside were run as efficiently as the health service, many problems would be solved.

To ask the Secretary of State for Health what percentage of gross domestic product is spent on health in (a) the United Kingdom and (b) other European countries.

It is estimated that total United Kingdom spending on health as a proportion of GDP will be 6.5 per cent. this year, compared with 5.8 per cent. in 1980. We do not yet have comparable figures for other European countries.

That is hardly surprising, as such figures would show that the percentage of GDP spent on health in the United Kingdom is significantly less than that spent in other European countries—and the GDP figure is lower as well. According to the findings of various surveys, the United Kingdom spends between 50 and 70 per cent. of the amount per patient spent by France and Germany. Given those figures, how can the Secretary of State possibly deny that the national health service is suffering from chronic and debilitating underfunding?

The hon. Gentleman should beware of such naive comparisons. The Netherlands, for example, includes nursing homes in its health figures. [Interruption.] I refer to the 1988 figures. If we did the same, our spending figures would be increased by 0.25 per cent.

In many respects, the figures are not comparable. The figures relating to output are far more important. Our perinatal mortality record is now better than that of the United States, although that country spends nearly twice as much of its GDP on health. What matters is the efficiency of the health service, not the result of crude comparisons.

As we are comparing Britain's health service with its counterparts on the continent, may I ask whether my right hon. Friend has read an article that appeared this week in the British Medical Journal and which highlighted the enormous number of complaints from Italian patients, who are required to take their own bed linen and food into hospital and have to tip lavishly to attract any attention? Is my right hon. Friend aware that doctors, nurses, medical auxiliaries and pharmacists all over France were on strike last week, protesting about the French health service and, in particular, the cuts Unposed by the French Government? Does my right hon. Friend therefore agree that in health matters the grass is not greener on the other side of the channel?

My hon. Friend's observations confirm that we have a health service to be proud of—recent polls show that up to 80 per cent. of people are satisfied with it, including waiting times—and we are seeking to make the service more efficient. The real questions should be addressed to the Labour party. The hon. Member for Livingston (Mr. Cook) recently tipped the wink to the British Medical Association that under Labour about £6 billion extra would be available per year. That was reported in the British Medical Journal, although the hon. Gentleman provided no press handouts, any more than he provided press handouts in relation to COHSE. If he wishes to deny that statement, let him do so.

To ask the Secretary of State for Health whether the anonymised screening programme for HIV is being extended; and if he will make a statement.

The first results of the anonymised HIV surveys have provided valuable information about the prevalence of HIV infection in England. The number of participating clinics will increase throughout England and Wales as the surveys continue.

Will the Minister confirm that "anonymised" screening is truly anonymous, and that there is no way in which a positive result can be traced back to any individual? Does she agree that the programme will provide valuable information only if it covers a wide enough spread of the population and if that spread is maintained for a number of years?

The screening survey has already proved its usefulness in allowing us to plan services and the development of preventive measures. I can confirm that the testing is entirely anonymous. It is essential that we have fact, not fantasy, on which to work in dealing with the spread of HIV and AIDS which are, after all, the most serious threat to public health this century. That is why we have made it clear from the outset that special resources should he directed deliberately towards research, prevention and services.

To ask the Secretary of State for Health if he will undertake an assessment of the need for, and availability of, extra-corporeal membrane oxygenator baby life-saving units.

Yes, Sir.

Will the Minister assure us that the EC MO baby life-saving unit in the Groby road hospital in my constituency will have enough funding to continue in existence? Is he aware that unless public funding comes through, that unique unit will almost certainly have to close, resulting in a serious, unnecessary and scandalous loss of babies' lives?

I am pleased to be able to give the hon. and learned Gentleman, who is my parliamentary neighbour, the assurance that that will not happen. I spoke to Mr. Field, the clinician in charge, on the telephone this morning, and he will meet Professor Peckham, the director of research and development of the NHS, on 4 July.

Is not it true that nearly twice as many babies died when the Labour party was last in power, whereas we have succeeded in cutting the death rate from 8.2 per thousand to 4.6 per thousand?

My hon. Friend is absolutely right. That is one of the health indicators that have improved dramatically in the past 12 years.

To ask the Secretary of State for Health if he will make a statement on capital expenditure in the health service between 1971–72 and 1991–92.

To ask the Secretary of State for Health what is the level of capital investment in the national health service in 1991–92; and what was the figure in 1978–79.

Capital expenditure in the national health service in 1991–92 is planned to be 60 per cent. higher in real terms than in 1971–72 and 68 per cent. higher than in 1978–79.

Will my right hon. Friend confirm that capital expenditure today is almost double what it fell to when Labour cut expenditure in 1977–78? Does he agree that there is much more machinery, equipment and electronics in the health service than there was before, and that we now have lithotripters and magnetic resonance imaging equipment, none of which existed under Labour in 1979?

One of the most disgraceful aspects of the previous Labour Government's record was their catastrophic cut in spending on the health service after the International Monetary Fund arrived in this country. The hon. Member for Livingston (Mr. Cook) usually says he voted against that, but in fact, as we discovered, he abstained. For example, we now have MRI scanners, lithotripters and mammography equipment, and defibrillators are present in every front-line ambulance. We have a better-equipped health service.

Does my right hon. Friend have on file a Trades Union Congress report criticising the Government for hospital closures and cuts in the NHS capital investment programme? Will he contrast that report, which was published in 1978 under the last Labour Government, with more recent news of more than 500 major hospital building projects being undertaken, millions more patients being treated and almost £33,000 million to spend on patient care this year?

I confirm that that is so. On the 30th anniversary of the health service, the TUC made a tremendous but justifiable attack on the then Labour Government. Now, however, the hon. Member for Livingston, by nods and winks—by going to the BMA, by saying yes to every pressure group and by promising expenditure that he knows, if he took on my job, he would not be able to honour—is building up the same explosion of resentment and failed expectations as that which occurred under the last Labour Government, causing the winter of discontent and bringing catastrophe to the health service.

Returning to the comments of Mr. Hector MacKenzie, in the context of this question does the Secretary of State think that the national health service should act against the interests of its own staff?

Of course not. I know that the hon. Gentleman, who is sponsored by COHSE, would not believe that to be so, but it is an extraordinary statement not to put first that the national health service should act, above all, in the interests of patients.

If everything has been so good with the national health service during the course of this Tory Government's 12 years, why are wards and hospitals closing, beds being shut down and more than a million people on waiting lists, and why are GP fundholders at a practice in north Derbyshire able to get their patients into hospital six weeks before others who are not GP fund holders?

The hon. Gentleman may have missed the agreement that was made with the profession last week, which laid to rest such scare stories. I make no apology for the policy of closing hospitals that are no longer needed; in saying that, I am quoting the Secretary of State for Health under the last—and I mean last—Labour Government.

To ask the Secretary of State for Health if he will make a statement on the preparation for improving health care in their areas made by the NHS trusts since their establishment in April.

The NHS trust programme is already delivering widespread improvements in patient care.

Is my hon. Friend aware that the myths and allegations put forward by the Opposition parties about NHS trusts are being met by the reality of success, expansion and the recruitment of consultants and other staff, not only by the Taunton and West Somerset trust in my constituency but in east Somerset, Weston, Bristol, and Devon and Cornwall? Has my hon. Friend noticed that the Devon branch of the National Union of Public Employees has welcomed the application and the plans being made by the Devon ambulance service to become an NHS trust?

I have noticed the attitude of the Devon branch of NUPE. I hope that the more inspired approach of that branch will be applied in competitive tendering, which we discussed earlier.

On the improvement in patient care which is attributable to the trust programme, my hon. Friend may like to observe what is happening on Merseyside. There is investment of £1.3 million in the kidney service at the Royal Liverpool university hospital and a new lithotripter has been installed so that more patients can be treated on a day-care basis. There are 84 beds for heart patients in the new building at the cardio-thoracic centre in Liverpool. There is also investment of £4.5 million at Broadgreen hospital in Liverpool to build a new 96-bed psychiatric unit. Those are examples of improvements in patient care being brought to Merseyside as a result of the trust programme.

In that case, how can the Minister justify the closure of St. Paul's eye hospital in Liverpool and the decision—announced yesterday, when I went to see the chairman of Liverpool health authority—to close a second general hospital, leading to a reduction in the number of beds available for psychiatric patients?

If local disagreements come to the attention of Ministers, we shall consider the cases then. I had hoped that the hon. Gentleman would take the opportunity to welcome the fact that on Merseyside we have far and away the best record on waiting lists in the NHS—they are down by one quarter compared with 1979. Since 1979, the number of in-patients treated has increased by 29 per cent. and the number of day cases treated has increased by 86 per cent. The health service on Merseyside is a success. If only other local services were so successful.

Does my hon. Friend agree that one of the most important benefits of the trust programme has been the tremendous increase in staff motivation? Does he agree that if the NHS is to be seen to be improved, staff motivation will be one of the cardinal characteristics of that improvement?

My hon. Friend is absolutely right. The trust programme is a means of providing staff of all levels in the health service with a greater opportunity to influence the output of the health service and the treatment of patients in their units. It gives local ownership to the service that is delivered. That is good for the staff and for the patients.

Is the Minister aware that in an interview with the South London Press, Sir Philip Harris, a former furniture tycoon who now chairs Guy's hospital trust, justified meeting in secret to axe jobs and services because, as he said, otherwise it would slow the whole process down? Sir Philip said:

"What we can't do is have open debate"—

Order. No quoting, please. Paraphrase.

Does the Minister think that it is right that Guy's hospital trust should meet in secret? Does he agree with the chairman's belief that the trust should act "as a company"?

It is right that the health service should have the skills of effective management at its disposal. If the trust programme can recruit, through its assistance, people who are capable of delivering a more effective service to patients, that is justification enough for me.

To ask the Secretary of State for Health what arrangements he proposes to make to permit general practitioners whose practices are too small to qualify for budget holding to obtain treatment for their patients outside their own districts; and if he will make a statement.

All GPs will continue to be able to refer patients in line with their clinical judgment. Contracts for health services will provide a more effective way of giving practical effect to GPs' referral decisions.

My hon. Friend's reply should show GPs that the rules are flexible enough to enable them to refer patients outside their districts for treatment at other hospitals, even though their practices may be too small for budgeting. How do this year's referral figures compare with last year's, now that there are new rules?

The key point is that for the first time district health authorities have been working closely with general practitioners about where they want to refer patients. That means that it is possible to build on improvements in service, take quality into account and negotiate more effective targets for the future. Contracts have been placed to cover 95 to 99 per cent. of GPs' likely referral needs.

To ask the Secretary of State for Health if he will make a statement on the draft European Community directive on the advertising of medicines.

The draft EC directive is broadly consistent with existing United Kingdom legislation.

Does my hon. Friend agree that pharmaceutical companies make a substantial contribution to the funding of postgraduate medical education? Does he further agree that the draft directive, as it stands, would considerably restrict the ability of pharmaceutical companies to continue to provide such funding? Will he do all that he can to get it across to the powers that be in Brussels that the directive represents a considerable threat to the funding of postgraduate medical education in this country?

I certainly share my hon. Friend's determination to ensure that such a threat does not materialise. We regard it as essential that the directive should not in any way restrict the sponsorship that the pharmaceutical industry rightly provides for genuine educational and scientific projects in the form of research and conferences.

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

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.

Can the Prime Minister define the term "Majorism"? Does it mean reducing inflation from the level that the Government have created? Does it mean increasing unemployment to more than 2–5 million? Or does it mean failing to invest in our manufacturing industry? What is Majorism?

The hon. Gentleman would be well advised to read the speeches that I made at Scarborough, Southport, Swansea and elsewhere. It involves extending choice and opportunity more widely, bringing quality to our public services, a strong economy with low or nil inflation, letting people spend more of their own money in their own way, maintaining firm defences and giving choice back to people, which is where it should be.

Does my right hon. Friend agree that negotiating vigorously and directly with our European partners is the best way to arrive at a common approach to those political and economic issues that are in the best interests of Britain? Does he further agree that such an approach should be based on what is practical, realistic and evolutionary rather than engaging in rhetoric or working on a blueprint for federalism?

I entirely agree with my hon. Friend. A European super-state would not be acceptable to me or to the House—and in my judgment it would not be acceptable to the country.

Would the Prime Minister say that the large fall in manufacturing output over the past 12 months was evidence that his policies are working?

As the right hon. Gentleman is aware, the best possible future for manufacturing industry is to ensure that the economy has the lowest possible inflation and the prospect of growth again. That is where the prospects for manufacturing industry come from; without that secure base, manufacturing industry would face problems for a long time.

Does the Prime Minister not yet realise that by keeping on with his high interest rate policies he is making his recession deeper and longer, and causing a permanent loss of capacity in British industry? What sort of preparation does he think that that affords for the completion of the single market next year?

The single market would not have come about but for the efforts of this Government, and there has not been a great deal of support from the Opposition. There are no good prospects for any part of the economy without low inflation. We are now delivering low inflation in a way that the right hon. Gentleman's policies never could.

At what point, then, will unemployment have increased enough, investment have fallen enough, enough companies have been closed and manufacturing output have fallen low enough to justify the Government cutting interest rates, which are the cause of the loss of capacity that threatens British industry?

The right hon. Gentleman's prescription is wrong. He will recall that on many occasions in recent months Opposition Front-Bench spokesmen have suggested that I per cent. off interest rates would make a material difference. We have had 3.5 per cent. off interest rates in the past few months—and inflation has moved towards half what it was some months ago—and the figures are still coming down.

As this Government are the first in history to spend more on health than on defence, does not my right hon. Friend find it deplorable that the hon. Member for Livingston (Mr. Cook), in his keynote speech to the Confederation of Health Service Employees, personally attacked—

Order. The hon. Gentleman has been here long enough to know that he must ask a question that falls within the Prime Minister's responsibility.

Should not the country know that the national health service trust in Bradford means an additional £1 million in health care for patients, and that at Guy's hospital the trust means more patients treated? The minimum wage that the Labour party offers would starve the health service of £500 million.

I believe that my hon. Friend's strictures are all correct. There is an increasing wealth of good news about the activities of national health service trusts, and the second wave of trusts in due course will bring even more good news and better service for the patients in the national health service, which is our intention.

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

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

Does the Prime Minister agree with the view of the right hon. Member for Finchley (Mrs. Thatcher), propounded in Chicago yesterday, that a single European currency would take the heart out of the purpose of this Parliament?

If this Parliament believed that, it would not vote for it and it would not happen.

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

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

Does my right hon. Friend agree that the example of Liverpool provides in microcosm the most salutary lesson of the consequences of a Labour Government?

I would most certainly agree. It is an illustration of Labour government in practice which I believe the country will observe and not like.

Is the Prime Minister aware that whatever pillars may be involved in the construction of the European temple, a defence pillar is not yet considered practical and workable within western alliance parliamentary circles and nor is it considered desirable in eastern Europe? Does he agree that nothing which might cut across NATO's rule or duplicate its military structure is desirable?

First, I congratulate the hon. Gentleman on his well-deserved honour in the Queen's birthday honours list. I entirely agree that our defence interests are such that they must be based on NATO in the future, as they have been in the past. NATO has served us outstandingly well over the past 40 years and it will, I trust, serve us equally well in the future.

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

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

In the course of his busy day, will my right hon. Friend consider the consequences of the abolition of the dock labour scheme, which will lead to much greater activity in scheme ports such as Liverpool, giving them the chance to prosper again? Is it not significant that those who were loudest in their objections to the abolition of the scheme are now silent in its defence?

I will certainly consider the consequences of the abolition of the dock labour scheme, and I believe that they are very attractive. The House will recall that the abolition of that scheme was passed through the House in the teeth of opposition from the Labour party. Yet in Liverpool productivity has improved by at least 20 per cent. since the abolition of the scheme and will improve similarly elsewhere in the country. What we have seen in Liverpool, not only in the dock labour scheme but elsewhere, is the clearest possible illustration that the Labour party is locked in the past and has no place in the future.

What is the Prime Minister's reply to those who argue that the Government's current troubles are due to indecisiveness at the very top?

I can be wholly decisive and tell them that they are wrong.

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

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

Will my right hon. Friend confirm that the Government will resist every attempt, whether from Europe or from the Labour party, to pressurise us to have a minimum wage? Is my right hon. Friend aware that, in addition to the extra unemployment that it would create, it would particularly hit those who find it difficult to find jobs now, such as the disabled, women and ethnic minorities—a lesson which is understood by Mr. Eric Hammond, even if it is not understood by the leader of the Labour party.

I can give my hon. Friend a categoric assurance on that. The Labour party may continue with its policy of a minimum wage, but it has few friends left for it. As Mr. Hammond said just the other day:

"It would damage workers desperately and unless Labour can win the votes of such people, they will not win and will not deserve to."

He is right on both counts. They will not win and they certainly do not deserve to.

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

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

Bearing in mind the previous Prime Minister's commitment to give the highest priority to children's rights, as agreed at the summit last year, the Government's failure as yet to ratify the convention on the rights of the child and the almost daily reporting of the violation of children's rights in some form or another in Britain, will the right hon. Gentleman now give a pledge to implement the Gulbenkian recommendations to appoint a commissioner for children as the Labour party has pledged?

The hon. Lady should recognise that the Children Act 1989 is the best Act for the future of children that this Parliament has ever passed.

In the light of a possible rail dispute, will my right hon. Friend have another look at employment legislation and, in particular, the possible introduction of measures designed to protect the consumer and the general public against strikes called overnight and at very short notice?

I shall be happy to do so.

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

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

Has the Prime Minister yet had time to consider the letter sent to him last week by the chief executive of the Scottish Salmon Growers Association describing the present plight of the industry due to the dumping on the European market of Norwegian salmon? In the past, the European Community has been slow to deal with these matters. As the future of many businesses are at stake, what steps do the Government intend to take to inject some urgency into dealing with the crisis?

I understand the problem of the Scottish salmon industry, which we are examining at the moment in the light of the letter that we have received. I propose to discuss that matter with my right hon. Friend the Secretary of State for Scotland and then I will reply fully.

My right hon. Friend commanded great support and confidence for his policy for safe havens for the Kurds. Is he aware that some of us are becoming deeply concerned about the possibility of the abandonment of the Kurds? Would not it be a good idea if British politicians speaking to American audiences reminded them of their responsibilities rather than talking drivel about Europe?

First, I congratulate my hon. Friend the Member for Cambridge (Sir R. Rhodes James) on his well-deserved honour bestowed in the Queen's 'birthday honours list. As my hon. Friend will know, our purpose in creating safe havens in northern Iraq was to provide immediate humanitarian relief in conditions of safety, and to create the confidence for the Kurds to return safely to their homes. I believe that had we not done so, many thousands and perhaps many hundreds of thousands of Kurds would have died. Happily, many of them have now returned safely home and the safe havens continue in being, for the purpose for which they were originally set up.

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

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

In the absence of refuse collection services in some parts of Liverpool for the past three months, does the Prime Minister agree that it is scandalous that Liverpool residents have been sent bills for £70.99 for poll tax unpaid by other people in that city? Does he agree that that offends against every principle of natural justice and that, in connection with the new local tax, there ought to be a provision in law to ensure a right to redress in such circumstances for citizens hit in that way?

The hon. Gentleman points out yet another example of the sheer inefficiency of the present Liverpool council, and the way in which the people of Liverpool have been extremely badly treated as a result of its activities. Residents' bills in Liverpool are undoubtedly a good deal higher than they need to be because, as the Labour leader in Liverpool has admitted, it costs four times as much to pick up litter in Liverpool as it does elsewhere. The conclusion for the people of Liverpool must be obvious—no Labour Members and no Labour council.

I have selected the amendment in the name of the Prime Minister.

I beg to move,

That this House notes with alarm the level of profits made by the water companies and the huge salary increases of senior management since privatisation; and condemns Her Majesty's Government for its failure to ensure that the interests of water consumers and the environment are given greater priority than the interests of shareholders.

Although Conservative Members may not think so., this debate is important because nowhere can we see more clearly than on the issue of water privatisation the priorities of a Conservative Government. The outrage of vastly increased water bills at a time of scandalous profits and massive leaps in salaries for the top management show that the Government care little for water consumers, just as they care little for the environment. With this Government, profits come first, so that the issues that we shall discuss today are serious.

I hope that the Under-Secretary of State, the hon. Member for Banbury (Mr. Baldry), who must be most grateful to his colleagues for raising points of order until he was able to arrive and who has been left to carry the can, will understand when I say that the debate raises issues that are serious enough to warrant the attention of the Secretary of State and of the Minister of State. Perhaps I should explain to the House why they are absent.

Where is the hon. Member for Dagenham (Mr. Gould)?

The Minister of State telephoned me yesterday to offer his apologies and to say that his absence meant no disrespect to the Labour party. He explained that he could not be present today because of an important engagement. He went on to explain that the Secretary of State could not be present because of an important engagement. In fact, the Secretary of State for the Environment is visiting the Minister of State in his constituency. The absence of the Secretary of State and of the Minister of State may or may not have been intended as a slight to the Labour party; that does not worry us. What matters is that it is a mark of disrespect to the millions of people who face hardship because of their water bills, to the families who are worried about the quality of the drinking water, and to everyone who cares about the environment.

Does the hon. Lady accept that it would also be in order for the Secretary of State for Social Security to be present in view of the considerable hardship that she has mentioned, and the fact that there is no rebate scheme or element of income support to help those on the lowest incomes who face fixed bills which they cannot afford to pay?

I am grateful for the hon. Gentleman's intervention, which highlights many of hon. Members' concerns. I hope that Conservative Members, who must have had representations from their constituents, as we have had from ours, will voice the worries and fears of many people.

Will the hon. Lady tell us where the hon. Member for Dagenham (Mr. Gould) is? Why is he not here this afternoon?

As I am responsible for Labour party policies on these matters, it is appropriate that I am here.

Today's debate is not only extremely important, but extremely timely. In recent weeks, the profits of the water companies have been announced. We have heard of the vast increases in salaries for top management. Only today we have had the report of the Director General of Water Services which shows that the interests of shareholders predominate over the interests of everyone else. That cannot be the right priority for an industry that is so fundamental to the needs and interests of everyone.

How does the hon. Lady explain the £4 million of investment that Northumbrian Water is putting in to the Teesside area which will be followed by investment all round the country on an unprecedented scale to repair old sewers and water pipes which are falling in because the previous Labour Government slashed investment in the industry?

I am sure that the hon. Gentleman has read the annual report published today. It shows us in detail the shortfall in investment programmes—and I will come to that point later. I am sure that the House wants to be reminded of the figures for investment under the previous Labour Government compared with the figures for investment under the Conservative Government since 1979. During the period of the previous Labour Government, the average annual investment was £1,254 million a year. During the years of Conservative Government since 1979, the average investment in the water industry has been £922 million. That is the answer to the hon. Member for Stockton, South (Mr. Devlin).

I fear that the hon. Lady's figures are grossly misleading. I have the actual figures before me. During the period of the previous Labour Government, investment at 1989 prices fell from £1·4 billion to £1·1 billion. Under the Conservative Government, investment has risen from just under £1 billion to almost £2·4 billion in the current year.

The hon. Gentleman has proved that he cannot read statistics either. He raises an interesting question. It is not long ago that the water industry was not considered to be part of the realm of party politics and party debate. It is not long ago that the objectives for the water industry were similar among all parties. That has been the case since the Victorian era. I remind Conservative Members that it was the Conservative Joseph Chamberlain—and I am glad to see the hon. Member for Stockton, South nod in agreement—who said of the water industry:

"It is difficult and indeed almost impossible to reconcile the rights and interests of the public to the claims of an individual company seeking as its natural and legitimate object the largest private gain."

Much of the advance in life expectancy and many of the triumphs over disease were as much an achievement of better water supplies and better sewerage systems as an achievement of medical breakthrough. The House should remind itself of what has changed since those days.

In the past few years the Government, hamstrung by their dogma and extremism, have looked round for other industries to privatise. There was little left, so they descended on the water industry. There was a feeling in the water industry that the Conservative Government had deliberately held back investment to pave the way for privatisation.

Some callous remarks of the Ministers of the day should have prepared us for what has happened since. When answering a question about water quality and water bills, the former Secretary of State for the Environment, the right hon. Member for Cirencester and Tewkesbury (Mr. Ridley), uttered the immortal words, "Let them drink Perrier." Given that attitude, what has followed is perhaps not surprising.

Let us consider what has happened to the water industry in the past 18 months. I start with price increases. I remind the House that it was the present Secretary of State for Employment who promised during the Second Reading of the Water Bill in 1988:

"We are determined to ensure that the customer gets these benefits … in the price that he pays for water".—[0fficial Report, 8 December 1988; Vol. 143, c. 525.]

Since that statement, there have been large price increases, such as in the year of privatisation. Water charges have increased by 30 per cent. on average, with every company forcing through the maximum price rises on virtually every occasion. In the past three years, the increases have amounted to more than 50 per cent. for some consumers.

As the hon. Lady is clearly setting her face against the idea of price increases, and as the Labour party is committed to renationalising the water industry, where is the money to come from?

Many people are worried about where the money is going at present.

The price increases that I have quoted have been the average increases across the country as a whole. The position has been much worse for many people, especially where companies have overloaded their increases on to standing charges, thus often hitting hardest those who can least afford to pay more. Welsh Water has increased its standing charges by 60 per cent., presumably as part of its campaign for a flat-rate charge for every house in Wales, which is what some of my hon. Friends have called "the water poll tax". Other companies have adopted a similar approach.

I am sure that many colleagues have, like me, received letters almost daily from their constituents, especially from pensioners who keep a close record of their spending. A letter from one of my constituents shows that in the past two years the standing charges in the Yorkshire Water area have increased by 125 per cent. for sewerage and by 162 per cent. for water.

At one time, water bills were a relatively minor item of expenditure, but they are now a major problem for many families and cause grave hardship. That is why, in the past year, more than 900,000 summonses have been issued to people who could not pay their water bills.

I appreciate my hon. Friend's references to standing charges because of which it is significant to note that the people who use the least pay the most in unit costs for their water. My hon. Friend has referred to what has happened in the Yorkshire Water area in the past 18 months, but if she goes a little further back she will see that standing charges have increased by nearly 400 per cent. in the past five years. She is therefore correct to draw attention to standing charges, on which I hope that she will dwell a little further because they most affect those who use the least.

My hon. Friend is right. From his long interest in the water industry, I know that he will share my concern about the problems facing many households and families. Indeed, some of his constituents have had extra problems because of metering trials in their areas.

My hon. Friend has referred to the 900,000 people who have received summonses. Will she remind the House that the hardship that they face is not only the summons itself and the fact that very often the court costs amount to more than the one month's instalment that has been missed, but there is the far more important fact that, once summonsed, those 900,000 people will be placed on credit blacklists, as a result of which people who cannot afford to buy things outright are debarred from credit and even from rentals, and that that punishment stays with them for six years?

My right hon. Friend is right. The problem causes all sorts of hardship to the families involved. One of the horrors is that many of the families affected previously had no form of debt whatever and had not got into such difficulties.

I am grateful to the hon. Lady, especially as she has given way several times. Let there be no doubt that hon. Members on both sides of the House are worried about those who find themselves in debt. However, with great respect, the hon. Lady has not yet answered the point made by my hon. Friend the Member for Hertfordshire, West (Mr. Jones). He said that, faced with a £28 billion investment programme and a commitment to nationalise, the Labour party would have to find the money either out of taxation or, in fairness, out of prices. If she would reduce prices, where would the money come from?

The hon. Gentleman must bide his time. I shall come to the question of profits shortly. Before that I want to talk about some of the other burdens faced by many people, especially those who are worried about the possible introduction of metering, which could have a devastating effect on many families.

The Opposition are totally against universal compulsory metering or, indeed, any form of metering designed solely to enhance the profits of the water companies. No one should be denied access to water simply because of price, not least in view of the public health implications. Those who advocate metering as a solution should look carefully at the trials that have taken place, including those in the constituency of my hon. Friend the Member for Normanton (Mr. O'Brien). Many hardships and problems have been created by metering.

I have dealt with what has been happening to prices. In view of what has happened to prices during the past 18 months, it is perhaps not surprising that profits have rocketed. The profits for this year range from 17 per cent. for Thames Water and 60 per cent. for Southern Water, at the bottom of the list, to 185 per cent. for North West Water, 224 per cent. for Welsh Water and an incredible 369 per cent. forecast profit for Northumbrian Water. Those figures are so staggering that they need little further comment. But they must be seen as a slap in the face to all consumers.

The increased profits have been matched by increased salaries for top management. Many salaries have doubled in the two years or so since privatisation. Figures were published in The Sunday Times last week. Most of them were accurate, although I ought to make one correction. The chairman of Anglian Water has taken a salary cut. His salary has now fallen to £71,000 because he has gone part time. However, for chairmen and top managers that is not the end of the story. As well as huge salary increases, top management has also had very lucrative perks, not least the share options at flotation.

I have here the figures for the gains that would have been made by senior managers if they had taken up their full share option and sold at midday yesterday, which was not when prices were at their peak. Last year's accounts showed that more than 10 million shares were made available to chairmen, executive directors and others in senior management. I shall give a few examples of what that perk could have meant in practice. The chairman of Anglian Water came off worst. His share option would have realised £22,000 if it had been sold yesterday. The chairman of North West Water was given an option on 122,000 shares and would have made a profit yesterday of £74,000. He is not alone in that bracket.

Will my hon. Friend comment on the observations of many of my constituents in Cumbria and the north-west of England who feel concerned about the figures that were published in The Sunday Times at the weekend? They cannot understand how the water authorities can find money to pay such exorbitant salaries and make investments in companies that have nothing to do with the water industry, while at the same time major works remain outstanding on, for example, sewer outfalls, sewage plants and the relining of sewers. People want the authorities to spend their money in those important areas.

People in the north-west will be concerned about the chairman of North West Water being able to make over £74,000 from the disposal of his shares. The share option that was made available to senior management should not, in the view of most water ratepayers and consumers, have been a first priority.

Not only has the chairman of North West Water had that advantage. The chairman of Severn Trent Water could have realised £69,000; the chairman of Thames Water, £71,000; and the chairman of Welsh Water, had he sold his shares yesterday, could have realised £78,300. That is all in addition to their salaries. The perks to top management may have brought them in total as much as £10 million, all in addition to their salaries.

Has the hon. Lady evidence to suggest that any of those people have disposed of their shares, or is she uttering just a nasty little innuendo?

I wonder what the hon. Gentleman thought was the purpose of the share option at the time. It is common for directors to be given such perks. I am complaining about that type of priority taking precedence over the need for investment in the water industry.

rose—

I have given way once to the hon. Gentleman. [HON MEMBERS: "Give way".]

Order.

On a point of order, Mr. Speaker. Do you agree that, when people outside the House are referred to, we have a duty to ensure that what is said is true, since it may be repeated outside? Have you had any intimation from the hon. Lady that what she is saying about people in the water industry is true?

We must all calculate the weight we put on the freedom of speech which we enjoy here. What the hon. Lady has said is not a matter for me, and I have no idea whether or not it is true.

On a point of order, Mr. Speaker. Is it in order for the hon. Lady to say that the perks to which she referred took priority over investment decisions when the water industry currently has a £28 billion investment programme?

It is in order for the hon. Lady to make her own speech in her own way. Thanks to the slightly earlier start that the debate has had, it may be possible for me to call the hon. Member to speak and to make those points.